Moon M S, Woo Y K, Lee K S, Ha K Y, Kim S S, Sun D H
Department of Orthopaedic Surgery, Catholic University Medical College, Kang-Nam St. Mary's Hospital, Seoul, Korea.
Spine (Phila Pa 1976). 1995 Sep 1;20(17):1910-6. doi: 10.1097/00007632-199509000-00013.
Thirty-nine adults and five children with active spinal tuberculosis and resulting kyphosis of the dorsal and lumbar spine who had combined posterior instrumentation and anterior interbody fusion were observed to determine whether the corrected spinal deformity could be maintained until solid fusion.
To evaluate the effectiveness of the combined two-stage procedure for treating kyphosis due to active spinal tuberculosis.
Until 1970, with all methods of treatment, kyphosis due to active spinal tuberculosis tended to increase during therapy. Most of the patients treated with these methods were not happy with this residual kyphosis, even though their disease was arrested or cured. Kyphosis became their main concern regarding further treatment.
A combined two-stage procedure, under the cover of 18 months of triple chemotherapy, was used for all patients. For posterior stabilization, the Harrington distraction system, Rush nails or Steinmann pins and wires, and Texas Scottish Rite Hospital instrumentation were used. The diagnosis of successful interbody fusion was made if there was no loss of correction, no graft resorption or graft bed resorption, and if there was visible graft remodeling, such as trabeculation between the graft beds and graft and the graft hypertrophy.
In the 39 adults, average preoperative, immediate postoperative, and last follow-up kyphosis angles were 37 degrees, 16 degrees, and 18 degrees, respectively. In four children, the average preoperative, immediate postoperative, and last follow-up kyphosis angles were 55 degrees, 28 degrees, and 31 degrees, respectively. The loss of correction did not exceed 3 degrees. For one-segment spondylodesis, the average fusion times were 4 months in adults and 3.5 months in children. For a two-segment fusion, the average fusion times were 6 months in adults and 6.3 months in children.
Posterior instrumental stabilization and anterior interbody fusion were found helpful in arresting the disease early, providing early fusion, preventing progression of kyphosis, and correcting the kyphosis.
观察39例患有活动性脊柱结核并导致胸腰椎后凸畸形的成人以及5例儿童，这些患者接受了后路器械固定和前路椎间融合术，以确定矫正后的脊柱畸形是否能够维持至牢固融合。
评估两阶段联合手术治疗活动性脊柱结核所致后凸畸形的有效性。
直到1970年，采用所有治疗方法时，活动性脊柱结核所致的后凸畸形在治疗期间往往会加重。尽管这些患者的疾病得到了控制或治愈，但大多数接受这些方法治疗的患者对残留的后凸畸形并不满意。后凸畸形成为他们进一步治疗的主要担忧。
所有患者均采用在三联化疗18个月的掩护下进行的两阶段联合手术。对于后路稳定，使用了哈灵顿撑开系统、鲁什钉或斯氏针及钢丝，以及德克萨斯州苏格兰 rite 医院的器械。如果没有矫正丢失、植骨吸收或植骨床吸收，并且有可见的植骨重塑，如植骨床与植骨之间的小梁形成和植骨肥大，则诊断为椎间融合成功。
在39例成人中，术前、术后即刻和末次随访时的平均后凸角度分别为37度、16度和18度。在4例儿童中，术前、术后即刻和末次随访时的平均后凸角度分别为55度、28度和31度。矫正丢失不超过3度。对于单节段脊柱融合术，成人的平均融合时间为4个月，儿童为3.5个月。对于双节段融合术，成人的平均融合时间为6个月，儿童为6.3个月。
后路器械稳定和前路椎间融合有助于早期控制疾病、实现早期融合、防止后凸畸形进展以及矫正后凸畸形。
