Surgical Treatment of Tuberculous Osteomyelitis of the Spine

手術治療結核脊椎骨髓炎

蔣岳夆(Yueh-Feng Chiang) ； 陳學明(Hsueh-Ming Chen) ； 曾永輝(Yang-Hwei Tsuang)

《北市醫學雜誌》 3卷8期 (2006/08) Pp. 798-807

https://doi.org/10.6200/TCMJ.2006.3.8.06

摘要

目的：幾十世紀以來，脊椎的感染一直是嚴重的疾病；即使近來診斷技術、化學治療藥劑、及手術發展一日千里，脊椎感染即使對最有經驗的脊椎外科醫師而言，仍然是嚴酷的挑戰。在脊椎感染中，結核性的脊髓炎因為發作緩慢、症狀不明確、卻會引起嚴重後遺症如結構破壞、畸形、及嚴重的神經後遺症如癱瘓等，需要臨床醫師特別注意。早期積極的處理，以根除病灶，是治療的首要目標。在病患有神經學缺損，不論是被骨髓炎的骨碎片或膿腫所壓迫，或在椎節出現不穩定時，我們建議手術治療以終止感染的擴散，避免遲發的畸形，以期盡早恢復神經學功能。方法：有三名72、73和84歲的老年人因為脊椎的結核性骨髓炎，合併有神經學症狀或不穩定，接受了外科處理。因為X光片及手術中並未發現不穩定,，所以在2名胸椎骨髓炎患者，我們只採取部分椎體切除及椎間盤切除術，並使用手術中需要切除的肋骨來填補切除後的骨缺損。另一病患患部在下腰椎區域，並且X光片出現明顯不穩定，因此部分椎體切除及椎間盤切除術外，我們同時施行後方內固定。結果：這3位病患經追蹤18個月至31個月，沒有復發感染。病患也恢復了行走能力。病患們都對治療結果感到滿意，且歸功於手術的療效。結論：臨床醫師不應該被一般治療原則誤導，對脊椎的結核性骨髓炎病患合併出現神經學缺損，或有不穩定的證據時，仍然使用保守的處理方式。這些病患應該敦促他們接受前方減壓，以骨移植填補缺損，再視椎節穩定與否加以內固定。至於採用前方或後方的內固定方式，則屬另一討論範圍，可交由臨床醫師自行決定。

關鍵字

結核分枝桿菌 ； 結核性骨髓炎 ； 椎骨體切除術 ； 支撐性骨移植

並列摘要

Background and Purpose: Infection of the spine is a serious morbidity for centuries. Even with the recent advances in diagnostic modality, chemotherapy agents and surgical techniques, infections of the spine have remained a formidable challenge to even the most learned of spine specialists(superscript [1,2]). Among infections of the spine, tuberculous osteomyelitis requests special care because of its insidious onset, nonspecific symptoms, its late sequela of structural destruction and deformity, and severe neurologic complications including paraplegia reported in literature(superscript [1,2,3]). Early and aggressive treatment should be given to eradicate the focus (superscript [3,4].) In such cases with neurologic deficit caused by direct compression of the dural sac, either by sequestrated fragments or cold abscess, or in cases with evidences of instability, operation is indicated to stop dissemination of infection, avoid late deformity, and restore neurologic function. Methods: Three senile patients with their ages being 72, 73 and 84 years underwent surgical treatment for tuberculous osteomyelitis of the spine due to either neurologic deficit or instability. Since there was no sings of instability both radiographically and surgically in the 2 thoracic vertebral ostoemyelitis patients, simple partial corpectomy and discectomy was performed with multiple rib grafts used to fill in the defects. The other case was involved in lower lumbar region and x-ray demonstrated gross instability, so anterior corpectomy, discectomy was followed by posterior instrumentation. Results: These 3 cases were followed from 18 months to 31 months with no recurrence of infection and regained ambulation. All of them were satisfied with the treatment and were grateful about the surgery. Conclusion: The clinicians should not be mislead to use conservative treatment for tuberculous spinal osteomyelitis in cases with neurological deficit or instability. These cases should be urged to anterior decompression with strut graft with or without instrumentation, dependent upon whether instability exists or not (superscript [5]). The use of anterior or posterior instrumentation is another issue and is left to surgeon's preference.

並列關鍵字

mycobacterium tuberculosis ； tuberculous osteomyelitis ； corpectomy ； strut graft