Mantero E, Casu F, Asquasciati G, Sènès F M, Risso S, Marazzi M G, Ratto S, Pinelli G, Tomà P
Università degli Studi di Genova, II Clinica Malattie Infettive Instituto Giannina Gaslini, Genova.
Minerva Pediatr. 1994 Jun;46(6):295-301.
We are currently witnessing a worldwide return of tuberculosis. An extremely rare form is tuberculosis of the spine which is reported above all in extra-European studies. The authors report a case of Pott's disease in a child aged 3 years and 3 months who was referred to their attention due to the appearance of left inguinal swelling, fever and anemia. Diagnostic tests (ETG, CT, MR) showed an abscess involving the L5-S1 intersomatic space, the intervertebral disc and osteolytic lesions of S1, with impairment of the left psoas muscle and diffusion as far as the inguinal region. Chemotherapy was commenced using isoniazid, ethambutol, rifampicin, and streptomycin and lasted 24 months associated with drainage of the ileopsoas abscess. Conservative orthopedic treatment lasting for one year initially took the form of decubitus in bed with hyperdistension of the vertebral column, followed by the creation of a plaster-cast cot on the back and lastly a glass-reinforced resin orthopedic jacket. The follow-up of 2 years and 10 months showed recovery with reconstruction of the vertebral elements and the preservation of intervertebral space.
我们目前正目睹结核病在全球范围内卷土重来。脊柱结核是一种极为罕见的类型,主要在欧洲以外地区的研究中有报道。作者报告了一例3岁3个月大儿童的波特氏病,该患儿因左侧腹股沟肿胀、发热和贫血前来就诊。诊断检查(ETG、CT、磁共振成像)显示脓肿累及L5 - S1椎体间隙、椎间盘以及S1的溶骨性病变,左侧腰大肌受累且扩散至腹股沟区。开始使用异烟肼、乙胺丁醇、利福平及链霉素进行化疗,持续24个月,并对髂腰肌脓肿进行引流。为期一年的保守矫形治疗最初是卧床体位,使脊柱过度伸展,随后制作背部石膏床,最后使用玻璃纤维增强树脂矫形夹克。2年10个月的随访显示病情恢复,椎体结构重建且椎间隙得以保留。