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年龄对脊柱结核前路清创术后畸形变化的影响。

The effect of age on the change in deformity after anterior débridement surgery for tuberculosis of the spine.

作者信息

Upadhyay S S, Saji M J, Sell P, Hsu L C, Yau A C

机构信息

Department of Orthopaedic Surgery, Duchess of Kent Children's Hospital at Sandy Bay, Hong Kong.

出版信息

Spine (Phila Pa 1976). 1996 Oct 15;21(20):2356-62. doi: 10.1097/00007632-199610150-00010.

DOI:10.1097/00007632-199610150-00010
PMID:8915071
Abstract

STUDY DESIGN

This article evaluates how an immature spine responds to anterior débridement surgery (without bone grafting) for spinal tuberculosis during growth and development. Sixty-three patients were studied, 29 of whom were children aged 10 years or less at the time of surgery, whereas the remaining 34 subjects were adults. These patients were the subject of the Medical Research Council Working Party's prospective study, started in Hong Kong in the mid-1960s.

OBJECTIVES

To evaluate how an immature spine responds to débridement surgery for tuberculosis, during growth and development, to determine whether there are differences in the longitudinal pattern of deformity between children and adults, and to determine the influence of disproportionate spinal growth on the progression of deformity in children.

SUMMARY OF BACKGROUND DATA

All patients were followed prospectively for a mean period of 19.6 years after débridement surgery. The mean age at surgery for children (n = 29) was 4.3 years and for adults (n = 34) 35.3 years.

METHODS

The kyphos and deformity angles were measured from lateral spinal radiographs obtained at preoperative evaluation and postoperatively at 6 months, 1 year, 5 years, and at final follow-up evaluation using an electronic digitizer.

RESULTS

The results showed that the longitudinal pattern of changes in the mean kyphos and deformity angles in young children presented a picture slightly different from that in adults. The mean angles were increased at the 6-month and at 1-year evaluations after débridement surgery in both groups. Afterward, in children there was some spontaneous correction in these mean angles, whereas in adults these angles showed variation according to the site of lesion during the follow-up years. Statistical analysis according to the site of spinal lesion showed that in thoracic tuberculosis, there was an increase in kyphos and deformity angles at the 6-months postoperative evaluation (more in children than in adults). There were no significant changes in these angles from the 1-year to the final follow-up evaluations. In thoracolumbar tuberculosis, there were significant increases in kyphos and deformity angles at the 6-month postoperative evaluation, and thereafter adults did not show any significant change until final follow-up examination, whereas children showed a tendency toward spontaneous correction, although this finding was not statistically significant. In lumbar tuberculosis, there was an equal tendency toward spontaneous correction in children and adults from 1 postoperative year onward.

CONCLUSIONS

The authors could find no evidence of disproportionate posterior spinal growth, which has been suspected in the past to be a factor involved in contributing to progression of kyphotic deformity after anterior débridement surgery for spinal tuberculosis.

摘要

研究设计

本文评估发育未成熟的脊柱在生长发育过程中对脊柱结核前路清创术(不植骨)的反应。共研究了63例患者,其中29例为手术时年龄在10岁及以下的儿童,其余34例为成年人。这些患者是医学研究委员会工作组于20世纪60年代中期在香港启动的前瞻性研究的对象。

目的

评估发育未成熟的脊柱在生长发育过程中对结核清创术的反应,确定儿童和成人在畸形纵向模式上是否存在差异,并确定脊柱生长不均衡对儿童畸形进展的影响。

背景资料总结

所有患者在清创术后均进行了平均19.6年的前瞻性随访。儿童(n = 29)手术时的平均年龄为4.3岁,成人(n = 34)为35.3岁。

方法

使用电子数字化仪,从术前评估以及术后6个月、1年、5年和末次随访评估时获得的脊柱侧位X线片测量后凸角和畸形角。

结果

结果显示,幼儿平均后凸角和畸形角的纵向变化模式与成人略有不同。两组在清创术后6个月和1年评估时平均角度均增加。此后,儿童的这些平均角度有一些自发矫正,而在成人中,这些角度在随访期间根据病变部位有所变化。根据脊柱病变部位进行的统计分析表明,在胸椎结核中,术后6个月评估时后凸角和畸形角增加(儿童比成人增加更多)。从1年到末次随访评估,这些角度没有显著变化。在胸腰椎结核中,术后6个月评估时后凸角和畸形角显著增加,此后直到末次随访检查,成人没有任何显著变化,而儿童有自发矫正的趋势,尽管这一发现无统计学意义。在腰椎结核中,术后1年起儿童和成人都有同等程度的自发矫正趋势。

结论

作者未发现脊柱后部生长不均衡的证据,过去曾怀疑这是脊柱结核前路清创术后后凸畸形进展的一个相关因素。

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