Schulitz K P, Kothe R, Leong J C, Wehling P
Department of Orthopaedics, Heinrich-Heine-University, Düsseldorf, Germany.
Spine (Phila Pa 1976). 1997 May 15;22(10):1150-5. doi: 10.1097/00007632-199705150-00016.
A study to analyze the changes of the spinal deformity during the growth period, with regard to different operations for spinal tuberculosis in children.
To quantify the changes in the kyphotic angle and the growth ratio of the fusion bloc during spinal growth for different fusion techniques.
Most of the publications dealing with spinal tuberculosis in children focused on the clinical outcome with regard to different conservative and operative treatments. There is little reliable information concerning the growth of the solidly fused kyphotic bone bloc and its influence on the changes of the kyphotic deformity after different operative procedures.
The study included 117 children operated on for spinal tuberculosis at the age of 2-6 years at the Ruttonjee Sanatorium in Hong Kong during the 1950s and 1960s. Lateral radiographs obtained postoperatively and 5 and 10 years after the operation were analyzed for the growth changes of the solidly fused bone bloc. These results were compared with the different operation techniques (e.g., anterior fusion, posterior fusion, combined anterior and posterior fusion, and anterior debridement without fusion).
The patients treated by anterior fusion showed the worst results with respect to the kyphotic angle. This was especially true when the lesion was located in the thoracic spine and several segments were involved. Regarding the growth ratio of the fusion bloc, only the combined fusion and the anterior debridement guaranteed an equal growth of the anterior and posterior height.
Radical anterior surgery for spinal tuberculosis destroys the anterior growth and limits the capacity for spinal remodeling. Therefore, it should be avoided, if it is not absolutely necessary, for the healing of the infection or the primary correction of the tuberculous deformity.
一项分析儿童脊柱结核不同手术方式下生长发育期脊柱畸形变化的研究。
量化不同融合技术下脊柱生长过程中后凸角及融合块生长率的变化。
大多数关于儿童脊柱结核的出版物聚焦于不同保守和手术治疗的临床结果。关于坚固融合的后凸骨块生长及其对不同手术操作后后凸畸形变化的影响，可靠信息较少。
该研究纳入了20世纪50年代和60年代在香港律敦治医院接受脊柱结核手术的117名2至6岁儿童。分析术后、术后5年和10年获得的侧位X线片，以观察坚固融合骨块的生长变化。将这些结果与不同手术技术（如前路融合、后路融合、前后联合融合以及前路清创不融合）进行比较。
前路融合治疗的患者在后凸角方面结果最差。当病变位于胸椎且累及多个节段时尤其如此。关于融合块的生长率，只有联合融合和前路清创能保证前后高度同等生长。
脊柱结核的根治性前路手术破坏了前方生长并限制了脊柱重塑能力。因此，若非绝对必要，为了感染愈合或结核性畸形的初次矫正，应避免采用该手术。
