Rajasekaran S, Shanmugasundaram T K, Prabhakar R, Dheenadhayalan J, Shetty A P, Shetty D K
Department of Orthopaedic Surgery, Ganga Medical Centre and Hospitals, Coimbatore, India.
Spine (Phila Pa 1976). 1998 May 15;23(10):1163-7. doi: 10.1097/00007632-199805150-00018.
A 15-year clinical follow-up of tuberculous lesions of the lumbosacral region.
To verify the hypothesis that the lumbar lordosis and the specific biomechanics of the lumbosacral region influence and alter the healing pattern and progress of the disease when compared with their effects in other regions of the spine.
An estimated 2 million or more patients have active spinal tuberculosis, and the global incidence of the disease is increasing. The involvement of the lower lumbar region and the lumbosacral junction is relatively rare, with few reports in English literature.
Of a total of 304 patients forming a part of a controlled clinical trial comparing two forms of therapy in spinal tuberculosis, 53 patients had involvement of L3 and below. The following data were studied in these patients: age at start of treatment, number of vertebra involved, vertebral body loss, progress of the angle of kyphosis, and anterior and posterior growth of the involved segment during a period of 15 years. Student's t test for independent samples was used for statistical analysis.
The fourth lumbar vertebra was the most common vertebral segment involved, and the lumbosacral junction was affected in 12 patients. The average pretreatment kyphosis was 6.4 degrees and increased to 10.2 degrees at the end of 15 years. The average kyphotio angle per vertebral body loss was 4.9 degrees, far less than in the dorsolumbar region in which kyphotic angles of 27-30 degrees have been reported. Children younger than 10 years old differed in clinical appearance and progress compared with those older than 17 years. They not only showed more extensive involvement but also had more deformity with the same vertebral loss. Twelve patients less than 10 years old had an average involvement of 3.1 vertebral bodies and an average vertebral loss of 2.2 bodies. In comparison, the average number of vertebrae involved was 1.9 (P < 0.01) and the vertebral body loss was only 0.87 (P < 0.01) in patients older than 17 years. Also, the average kyphosis was 6.4 degrees compared with only 4.2 degrees (P < 0.01) in adults. In patients older than 17 years, there was no change after 2 years, by which time the collapse was complete. Four of 12 patients less than 10 years old, showed progressive kyphosis caused by continued growth of posterior parts of the body (i.e., sequestrated hemivertebrae).
In tuberculosis of the lumbosacral region, the development of kyphosis is minimal in patients older than 17 years, when growth has already stopped, and deformity is expressed more as foreshortening of the trunk. Children younger than 10 years old have more severe involvement with increased tendency toward greater kyphosis. They are also prone to progressive deformity through the years when the anterior growth plates are destroyed. Surgery is indicated in this group to prevent greater deformity.
腰骶部结核病变的15年临床随访。
验证以下假设，即与脊柱其他区域相比，腰椎前凸和腰骶部的特定生物力学影响并改变疾病的愈合模式和进展。
估计有200万或更多患者患有活动性脊柱结核，且该病的全球发病率正在上升。下腰椎区域和腰骶交界处受累相对较少，英文文献中报道较少。
在一项比较脊柱结核两种治疗方式的对照临床试验的304例患者中，53例患者L3及以下受累。对这些患者研究了以下数据：治疗开始时的年龄、受累椎体数量、椎体丢失、后凸角进展以及受累节段在15年期间的前后生长情况。采用独立样本的学生t检验进行统计分析。
第四腰椎是最常受累的椎体节段，12例患者腰骶交界处受累。治疗前平均后凸为6.4度，15年末增至10.2度。每个椎体丢失的平均后凸角为4.9度，远低于已报道的胸腰段27 - 30度的后凸角。10岁以下儿童与17岁以上儿童在临床表现和进展方面存在差异。他们不仅受累范围更广，而且在相同椎体丢失情况下畸形更严重。12例10岁以下患者平均受累椎体数为3.1个，平均椎体丢失2.2个。相比之下，17岁以上患者平均受累椎体数为1.9个（P < 0.01），椎体丢失仅为0.87个（P < 0.01）。此外，成人平均后凸为6.4度，而17岁以上患者仅为4.2度（P < 0.01）。17岁以上患者在2年后无变化，此时塌陷已完成。12例10岁以下患者中有4例出现因身体后部（即分离半椎体）持续生长导致的进行性后凸。
在腰骶部结核中，17岁以上生长已停止的患者后凸发展最小，畸形更多表现为躯干缩短。10岁以下儿童受累更严重，后凸增加的趋势更大。当椎体前缘生长板被破坏时，他们多年来也容易出现进行性畸形。该组患者需行手术以防止出现更严重的畸形。
