POSTERIOR INSTRUMENTATION AND ANTERIOR INTERBODY FUSION FOR TUBERCULOUS KYPHOSIS OF DORSAL AND LUMBAR SPINES
POSTERIOR INSTRUMENTATION AND ANTERIOR INTERBODY FUSION FOR TUBERCULOUS KYPHOSIS OF DORSAL AND LUMBAR SPINES
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DOI：
10.1097/00007632-199509000-00013
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发表时间：
1995-09-01
期刊：
影响因子：
3
通讯作者：
SUN, DH
中科院分区：
文献类型：
--
作者：
MOON, MS;WOO, YK;SUN, DH
研究设计。我们观察了39例成人和5例儿童的活动性脊柱结核，并合并后路内固定和前路椎间融合术，以确定矫正后的脊柱畸形是否可以维持到固体融合术。评价两阶段联合手术治疗活动性脊柱结核所致后凸的有效性。背景资料摘要。直到1970年，在所有的治疗方法中，由活动性脊柱结核引起的后凸在治疗过程中趋于增加。大多数用这些方法治疗的患者对这种残留的后凸并不满意，即使他们的疾病得到了遏制或治愈。后凸成为他们进一步治疗的主要关注点。在18个月的三联化疗的掩护下，所有患者都采用了联合两阶段的手术。后路稳定使用Harrington牵引系统，Rush钉或Steinmann销和钢丝，以及Texas Scottish Rite Hospital器械。如果没有矫正缺失，没有移植物吸收或移植物床吸收，如果有明显的移植物重塑，如移植物床与移植物之间的小梁和移植物肥大，则诊断成功的体间融合。在39名成年人中，术前、术后和最后随访的平均后凸角分别为37度、16度和18度。在4例患儿中，术前、术后即刻和最后随访时的平均后凸角分别为55度、28度和31度。校正损失不超过3度。对于单节段椎体融合术，成人平均融合期为4个月，儿童平均融合期为3.5个月。对于两节段融合术，成人平均融合期为6个月，儿童平均融合期为6.3个月。后路器械稳定和前路椎间融合术有助于早期遏制疾病，提供早期融合术，防止后凸的进展，并纠正后凸。
Study Design. 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.Objective. To evaluate the effectiveness of the combined two-stage procedure for treating kyphosis due to active spinal tuberculosis.Summary of Background Data. 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.Methods. 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.Results. 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.Conclusion. 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.