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脊柱结核

Tuberculosis of the spine.

作者信息

Leowattana Wattana, Leowattana Pathomthep, Leowattana Tawithep

机构信息

Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Rachatawee 10400, Bangkok, Thailand.

Department of Medicine, Faculty of Medicine, Srinakarinwirot University, Wattana 10110, Bangkok, Thailand.

出版信息

World J Orthop. 2023 May 18;14(5):275-293. doi: 10.5312/wjo.v14.i5.275.

Abstract

Pott's spine, commonly known as spinal tuberculosis (TB), is an extrapulmonary form of TB caused by Mycobacterium TB. Pott's paraplegia occurs when the spine is involved. Spinal TB is usually caused by the hematogenous spread of infection from a central focus, which can be in the lungs or another location. Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply, which can result in severe morbidity even after years of approved therapy. Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body. The clinical, radiographic, microbiological, and histological data are used to make the diagnosis of spinal TB. In Pott's spine, combination multidrug antitubercular therapy is the basis of treatment. The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection. Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care. Debridement, fusion stabilization, and correction of spinal deformity are the cornerstones of surgical treatment. Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.

摘要

波特氏脊柱病,通常称为脊柱结核,是由结核分枝杆菌引起的一种肺外结核形式。当脊柱受累时会发生波特氏截瘫。脊柱结核通常是由感染从一个中心病灶经血液传播所致,该中心病灶可能在肺部或其他部位。脊柱结核的特点是由相同节段动脉供血导致椎间盘受累,即使经过多年的规范治疗也可能导致严重的发病率。神经功能障碍和脊柱畸形是由椎体前部的渐进性损伤引起的。临床、影像学、微生物学和组织学数据用于诊断脊柱结核。在波特氏脊柱病中,联合多种抗结核药物治疗是治疗的基础。耐多药/广泛耐药结核病的出现以及人类免疫缺陷病毒感染的增加给抗击结核病感染带来了重大挑战。只有出现严重脊柱后凸或神经功能障碍的患者才需要手术治疗。清创、融合固定和脊柱畸形矫正术是手术治疗的基石。如果给予充分及时的治疗,脊柱结核的临床治疗效果通常相当不错。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/070c/10251269/6a348121b655/WJO-14-275-g001.jpg

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