前脊椎根治擴創及融合術治療脊椎結核

Tuberculous Spondylitis Treated by Anterior Radical Debridement and Fusion

劉添裕(Tian-Yuh Liou) ； 蘇光明(Kuang-Ming Su) ； 李土生(Tu-Sheng Lee)

《Journal of Orthopaedic Surgery Taiwan》 4卷4期 (1987/12) Pp. 170-178

摘要

脊椎結核約佔骨關節結核病的50%，是其中最常見、最危險的一種，如不及早治療，約10%會產生下半身麻痺、駝背等合併症。前脊椎根治擴創及融合術是於1956年由Drs. Hodgson及Stock所推廣，以此法治療脊椎結核而需手術之病患，有以下優點：（1）確定診斷，（2）立刻且顯著改善病況，（3）阻止膿瘍擴散，（4）促進早期骨癒合，（5）減少晚期合併症，（6）避免駝背，（7）避免下半身麻痺，（8）使下半身麻痺患者早期痊癒，（9）診治膿胸之合併症。
榮民總醫院台中分院骨科，自民國71年9月至75年6月，共有20例脊椎結核病患，採用此項手術療法。患者以55歲以上的老年人居多（60%），大多已有半身輕癱或麻痺等神經症狀（85%），病灶位置以胸椎居多。經兩週抗結核藥物治療後，給予手術治療，術後皆以石膏背架穿戴參個月，及半年至壹年的抗結核藥物治療，且長期追踪檢查（4個月～3年），結果令人滿意。
由以往文獻記載及本院結果顯示：（一）需手術治療的脊椎結核病患，愈早手術，效果愈好。（二）老年人雖然骨質疏鬆，仍以開刀治療為佳。（三）前脊椎根治擴創及融合術治療脊椎結核病是值得鼓勵的。

並列摘要

Tuberculous spondylitis, accounting for 50% of skeletal tuberculosis, is the most common and the most dangerous form of it. Ten percent of the improperly treated patients developed serious complications, such as paraplegia and kyphosis. Anterior radical debridement and fusion, popularlized by Hodgson and stock in 1956, has the following advantages: (1) provides definite diagnosis; (2) achieves dramatic improve-ment after evacuation of abscess; (3) pre-vents abscess extension; (4) accomplishes early bony fusion; (5) prevents late re-currence; (6) prevents the progression of kyphosis; (7) prevents paraplegia; (8) ini-tiates rapid recovery in established paraple-gia; (9) gives accurate diagnosis and exposure of lung penetration.
There were 20 cases of tuberculous spondylitis treated by anterior radical debridement and fusion at Veterans General Hospital-Taichung from Sept. 1982 to June 1986. Most of them were above 55 years old (60%) with neurological sequelae (85%) of paraparesis or paraplegia. The most common site of lesion in our series was thoracic spine. After more than 2 weeks of anti-tuberculous chemotherapy, surgical procedure was proposed, followed by 3 months of body jacket or Taylor brace application and half to 1 year of continuous anti-tuberculous chemotherapy. We have followed up these cases from 4 months to 3 years. The results are satisfactory.
Previous literatures and our results suggested that (a) if the patient needs operation, the sooner the operation, the better the result; (b) old patients with osteoporosis still had good results if oper-ated on; (c) with good functional recovery and bony fusion, anterior radical debride-ment and fusion in treatment of tuber-culous spondylitis is encouraging.

並列關鍵字

anterior fusion ； tuberculous spondylitis