一期病灶清除、椎间植骨融合及内固定术治疗脊柱结核的临床观察
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摘要
背景和目的:结核病一直是发展中国家最严重的传染病之一,我国庞大的人口基数决定了其患病人数必然众多。骨、关节结核是最常见的肺外结核病,其中脊柱结核占骨与关节结核发病总数的约一半以上。脊柱结核主要侵犯椎体,累及脊柱前、中柱,造成脊柱失稳、椎体塌陷、压迫脊髓,晚期发生后凸畸形。常规解决方法为一期病灶清除并植骨融合。但己有多项研究表明由于病灶己使该段稳定性遭破坏,植骨块往往在吸收重塑的同时不能提供足够坚强的支撑,从而导致植骨失败、后凸畸形未能纠正,故脊柱稳定性的重建问题越来越受到重视。随着脊柱外科和内固定技术的发展与进步,脊柱结核出现了新的治疗途径,即在常规病灶清除、植骨融合的同时,使用后路或前路内固定,试图为植骨块提供有效的支撑保护,以利其吸收重塑改建的同时保持脊柱稳定性,来防止后凸畸形的发生或进展。本文主要探讨一期彻底清除病灶和椎间植骨,通过坚强内固定矫正畸形和重建脊柱稳定性治疗脊柱结核的可行性及其治疗效果。
方法:①以大连医科大学附属第二医院2002年1月1日至2008年12月31日期间住院,确诊为脊柱结核的22例患者为研究对象。其中男14例,女8例,年龄25～74岁,平均39.4岁。病变分布:其中胸椎结核5例,胸腰段结核7例,腰椎结核10例,脊柱结核合并截瘫7例。本组患者均采用一期病灶清除、椎间植骨及内固定手术治疗,术前经正规抗结核药物治疗2～6周,术后继续抗结核药物治疗9～12个月。并获得完整随访。②设计脊柱结核各种病例登记表,详细记录每位患者的术前、术中、术后相关临床资料、影像学资料(X线片、CT片、MRI等)及化验检查资料(血沉、肝肾功能等),进行回顾性的总结与分析,并将统计数据输入统计软件spss11.5进行统计学分析。③随访观察患者手术前后临床症状;病灶及植骨愈合率;后凸畸形矫正及截瘫恢复情况。
结果:随访12～72月,平均33月。术后半年95%的患者血沉达到正常;所有22例患者的脊柱后凸角度(Cobb角)由术前平均40.2°矫正至22.9°,随访时平均26.0°,患者术后后凸畸形矫正率68%; 7例神经功能障碍者,术前其中Frankel分级为B级1例,C级2例,D级4例。术后7例均有不同程度恢复。植骨愈合情况经X线片复查,22例患者于术后3～6个月(平均4.6个月)植骨愈合,3～4月后均恢复了正常生活与工作。
结论:以标准结核化疗为基础,一期病灶清除、椎间植骨融合及内固定术治疗脊柱结核,可显著改善临床症状,重建脊柱稳定性,植骨愈合快,可预防或矫正后凸畸形,降低致残率,缩短卧床时间,具有可靠的临床应用价值。
Background and Objective:Tuberculosis has been one of the most serious infectious diseases in developing countries,and the number of tuberculosis patients is large in our country based on the huge population. Bone and joint tuberculosis is the most common extra-pulmonary tuberculosis, and more than half of which is spinal tuberculosis.Spinal tuberculosis mainly invades vertebrae,involving anterior and middle column,and causes instability of spinal,collapse of vertebra and spinal compression,and finally leads to kyphosis deformity.Conventional treatment is anterior partial vertebrectomy and fusion. However,many researches indicated that bone graft often could not provide firm support while osteolysis and remodeling since the focus had destroyed the stability of the spine segment,then resulted in failing to surgery or to correct the kyphosis deformity.So the re-establishment of spinal stabilization is being paid more and more attention to.With the development of spinal surgery and internal fixation,a new treatment of spinal tuberculosis appears recently,which combined conventional debridement,fusion and posterior or anterior internal fixation,trying to provide effective protection for the bone graft and keep the stability of the spine while osteolysis and remodeling,so that the occurrence or development of kyphosis deformity can be prevented.In this study,we investigate the feasibility and therapeutic effect of spinal tuberculosis with one-stage radical debridement,interbody fusion and internal fixation to restore stability of the spine.
Methods:①22 patients with spinal tuberculosis were treated by anterior partial vertebrectomy of the diseased vertebrae,iliac grafting and internal fixation from Jan 2002 to Dec 2008 hospitalization in the second affiliated hospital of Dalian medical university.Of the 22 cases, there were 14 males,8 females, from 25 to 74 years old,the average age of them is 39.4. There were 5 cases had the lesionsin in thoracic vertebraa,7 in thoracic-lumbar region and 10 in lumbar vertebra.There were 7 cases paralysis.All the patients were applied anterior partial vertebrectomy,Iliac grafting and internal fixation.The patients need routine 2 to 6 weeks anti-tuberculosis chemotherapy before operation,and continue antitubercu- losis chemotherapy for 9 to 12 months after operation.②Designing various kinds of registration tables about spine tuberculosis , recording the data of clinical,image (X-way,CT and MRI,and so on)and chemical examination (ESR,Liver and renal function,and so on),to perform retrospecttive study and analyses.③To follow-up clinical symptom,knitting rate and the rectification rate of kyphosis deformity.
Results:The average follow-up time was 33 months.95% of the patients' ESR recovered to normal.22 cases with kyphosis deformity were corrected from the preoperatively 40.2°to 12.9°postoperatively, but they were found to become 16.0°after 1 year.According to Frankel classification, the preoperative degrees of patients was 1 in Grade B,2 were in Grade C,4 were in Grade D and 15 were in Grade E.7 cases of neural dysfunction to restore to different extents after operation. All the 22 cases were cured in 6 months postoperatively.The later X-ray showed the solid fusion from all the 22patients of iliac grafting in 3-6months(average 4.6months) postopera- tively,at the same time,all the cases resumed their normal daily activities.
Conclusion:On the basis of effective chemotherapy,we believe that spinal tuberculosis with one-stage radical debridement,interbody fusion and internal fixation to restore stability of the spine has many advantages, including significantly improved clinical symptoms,thorough focus debride- ment,more rapid fusion of strut grafts,better deformity correction and vertebral column stabilization in patients who have kyphosis related to spinal tuberculosis,and shortening bed rest time as well.Therefore it has reliable value for clinical application.
方法:①以大连医科大学附属第二医院2002年1月1日至2008年12月31日期间住院,确诊为脊柱结核的22例患者为研究对象。其中男14例,女8例,年龄25～74岁,平均39.4岁。病变分布:其中胸椎结核5例,胸腰段结核7例,腰椎结核10例,脊柱结核合并截瘫7例。本组患者均采用一期病灶清除、椎间植骨及内固定手术治疗,术前经正规抗结核药物治疗2～6周,术后继续抗结核药物治疗9～12个月。并获得完整随访。②设计脊柱结核各种病例登记表,详细记录每位患者的术前、术中、术后相关临床资料、影像学资料(X线片、CT片、MRI等)及化验检查资料(血沉、肝肾功能等),进行回顾性的总结与分析,并将统计数据输入统计软件spss11.5进行统计学分析。③随访观察患者手术前后临床症状;病灶及植骨愈合率;后凸畸形矫正及截瘫恢复情况。
结果:随访12～72月,平均33月。术后半年95%的患者血沉达到正常;所有22例患者的脊柱后凸角度(Cobb角)由术前平均40.2°矫正至22.9°,随访时平均26.0°,患者术后后凸畸形矫正率68%; 7例神经功能障碍者,术前其中Frankel分级为B级1例,C级2例,D级4例。术后7例均有不同程度恢复。植骨愈合情况经X线片复查,22例患者于术后3～6个月(平均4.6个月)植骨愈合,3～4月后均恢复了正常生活与工作。
结论:以标准结核化疗为基础,一期病灶清除、椎间植骨融合及内固定术治疗脊柱结核,可显著改善临床症状,重建脊柱稳定性,植骨愈合快,可预防或矫正后凸畸形,降低致残率,缩短卧床时间,具有可靠的临床应用价值。
Background and Objective:Tuberculosis has been one of the most serious infectious diseases in developing countries,and the number of tuberculosis patients is large in our country based on the huge population. Bone and joint tuberculosis is the most common extra-pulmonary tuberculosis, and more than half of which is spinal tuberculosis.Spinal tuberculosis mainly invades vertebrae,involving anterior and middle column,and causes instability of spinal,collapse of vertebra and spinal compression,and finally leads to kyphosis deformity.Conventional treatment is anterior partial vertebrectomy and fusion. However,many researches indicated that bone graft often could not provide firm support while osteolysis and remodeling since the focus had destroyed the stability of the spine segment,then resulted in failing to surgery or to correct the kyphosis deformity.So the re-establishment of spinal stabilization is being paid more and more attention to.With the development of spinal surgery and internal fixation,a new treatment of spinal tuberculosis appears recently,which combined conventional debridement,fusion and posterior or anterior internal fixation,trying to provide effective protection for the bone graft and keep the stability of the spine while osteolysis and remodeling,so that the occurrence or development of kyphosis deformity can be prevented.In this study,we investigate the feasibility and therapeutic effect of spinal tuberculosis with one-stage radical debridement,interbody fusion and internal fixation to restore stability of the spine.
Methods:①22 patients with spinal tuberculosis were treated by anterior partial vertebrectomy of the diseased vertebrae,iliac grafting and internal fixation from Jan 2002 to Dec 2008 hospitalization in the second affiliated hospital of Dalian medical university.Of the 22 cases, there were 14 males,8 females, from 25 to 74 years old,the average age of them is 39.4. There were 5 cases had the lesionsin in thoracic vertebraa,7 in thoracic-lumbar region and 10 in lumbar vertebra.There were 7 cases paralysis.All the patients were applied anterior partial vertebrectomy,Iliac grafting and internal fixation.The patients need routine 2 to 6 weeks anti-tuberculosis chemotherapy before operation,and continue antitubercu- losis chemotherapy for 9 to 12 months after operation.②Designing various kinds of registration tables about spine tuberculosis , recording the data of clinical,image (X-way,CT and MRI,and so on)and chemical examination (ESR,Liver and renal function,and so on),to perform retrospecttive study and analyses.③To follow-up clinical symptom,knitting rate and the rectification rate of kyphosis deformity.
Results:The average follow-up time was 33 months.95% of the patients' ESR recovered to normal.22 cases with kyphosis deformity were corrected from the preoperatively 40.2°to 12.9°postoperatively, but they were found to become 16.0°after 1 year.According to Frankel classification, the preoperative degrees of patients was 1 in Grade B,2 were in Grade C,4 were in Grade D and 15 were in Grade E.7 cases of neural dysfunction to restore to different extents after operation. All the 22 cases were cured in 6 months postoperatively.The later X-ray showed the solid fusion from all the 22patients of iliac grafting in 3-6months(average 4.6months) postopera- tively,at the same time,all the cases resumed their normal daily activities.
Conclusion:On the basis of effective chemotherapy,we believe that spinal tuberculosis with one-stage radical debridement,interbody fusion and internal fixation to restore stability of the spine has many advantages, including significantly improved clinical symptoms,thorough focus debride- ment,more rapid fusion of strut grafts,better deformity correction and vertebral column stabilization in patients who have kyphosis related to spinal tuberculosis,and shortening bed rest time as well.Therefore it has reliable value for clinical application.
引文
1.卢世壁主译,坎贝尔骨科学,第9版,山东,山东科学技术出版社,2001;3022-3044.
2. Ito H,Tsuchija J,Asami g.A new radical operation for Pott’s disease,J Bone Joint Surg,1943;16:449.
3. Hodgson AR,Stock FE.Anterior spinal fusion.A preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia.Br J Surg,1956;44: 266-275.
4.方先之.骨关节结核病灶清除疗法(941例临床报告).中华外科杂志,1957,5:90.
5. Rajasekaran s,soundarapandian S.Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis Bone Joint Surg(Am),1989,71:1314-1323.
6.李承球,脊柱结核的诊断与治疗进展.颈腰痛杂志,1999,18(3):1890-1894.
7. Rajasekaran S,Shanmugasundaram TK.Prediction of the angle of gibbus deformity in tuberculosis of the spine.J Bone Joint Surg(Am),1987,69:503-509.
8. Lee EY,Hahn MS.A study of influences of the anterior intervertebral fusion upon the correctability of Kyphosis in tuberculous spondylitis.J Korean Orthop Assoc,1968;3:31-40.
9. Kim BJ,Ko HS,Lim Y,et al.the clinical Study of the tuberculous spondylitis.J Korean Orthop Assoc,1993;28:2221-2232.
10.瞿东滨,金大地.脊柱结核的一期手术治疗.中华医学杂志,2003,83(2 )110-113.
11.王自立,杨文宇,等.病椎部分切除、取髂骨植骨及内固定术治疗脊柱结核.中国脊柱脊髓杂志,2004;14(12)718-719.
12. Cengiz Y,Hakan YS,IlksenG,et al.Anterior instrumentation for the treatment of spine tuberculosis.1999,J Bone and Joint Surg,18(A):1261-1267.
13. H Mustafa Ozdemir,A Kemal Us,Tunc Ogun. The role of anterior spine instrumentation and allograft fibula for the treatment of Patt disease. Spine, 2003,28(5):474-479.
14. Sundararaj GD,Behera S,Ravi V,et al.Role of posterior stabilization in the management of tuberculosis of the dorsal and lumber spine.J Bone JointSurg (Br),2003,85:100-105.
15. Mehta JS,Bhojraj.Tuberculosis of the thoracic spine.J Bone Joint Surg(Br), 2001,83:859-863.
16. MRC Working on Tuberculosis of Spine. Controlled trial of short-course regimens of chemotherapy in the ambulatory treatment of spine tuberculosis. JBone Joint Surg(Br),1993,75:240-248.
17. Parthasarathy R,Sriram K,Santhd T,et al.Short-course chemotherapy for tuberculosis of the spine.J Bone Joint Surg(Br),1999,81:464-471.
18. Moon Ms,Woo YK,Lee KS,et al.Posterior instrumentation and anterior interbody fusion for tuberculosis kyphosis of dorsal and lumbar spines. Spine, 1995, 20(17): 1910-1916.
19.王自立,金卫东,等.超短程化疗方案及病椎部分切除术治疗脊柱结核.中华骨科杂志,2005,25(2):81-85.
20. Moon MS,Kim I,Woo YK,et al.Consevative treatment of tuberculosis of the thoracic and lumber spine adults and children.1987,11:315-322.
21.金大地,陈建庭,张浩,等.一期前路椎间植骨病内固定治疗胸腰椎结核.中华外科杂志,2000,38:900～903.
22. Oga M ,Arizono T,Takasita M,et al.Evaluation of the risk of instrumentation sa a foreign body in spinal tuberculosis.Spinal.1993,18:1890-1894.
23.周劲松,陈建庭,等.结核分枝杆菌对材料粘附能力的体外实验研究.中国脊柱髓杂志,2003,13-11:670-673.
24.郑晨希,饶书诚,等.椎体钉在胸椎结核手术治疗中的应用.中华骨科杂志,1992,12(6):401.
25. Yilmaz C,Selek H,Grkan I,et al.Anterior instrumentation for the treatment of spinal tuberculosis,J Bone Joint Surg(Am),1999,81(9):1261-1267.
26. Lee TC,Lu K,Yang LC,et al.Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar tuberculosis with early stage bone destruction.Neurosurg.
27.瞿东滨,等.手术治疗脊柱结核什么情况应用内固定.中国脊柱脊髓杂志,2004,14(12):712.
28.关晔.手术治疗脊柱结核什么情况应用内固定.中国脊柱脊髓杂志, 2004,14(12):714.
29.马远征.手术治疗脊柱结核什么情况应用内固定.中国脊柱脊髓杂志,2004,14(12):715.
30. Yilmaz C,Hakan K,Gurkan I,et al.Anterior instrumentation for the treatment of spinal tuberculosis.J Bone Joint Surg(Am),1999,81:1261-1267.
31. ?zdemir HM,kemal AU,Tun? ???n.The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease.Spine 2003;28:474-479.
32. Al-Sebai MW,Al-Khawashki H,Al-Arabi K,et al.Operative treatment of progress- sive deformity in spinal tuberculosis. Int Orthop 2001;25:322-325.
33. Benli IT,Kis M,Akalin s,et al.The results of anterior radical debridement and anterior instrumentation in Pott disease and comparison with othersurgical techniques.Kobe J Med Sci 2000;46:39-68.
34. Raraj AA.Anterior instrumentation for the treatment of spinal tuberculosis.J Bone Joint Surg Am 2001;83:463-464.
35. Parthasarathy R,Sriram K,Santha T,et al. Short-course chemotherapy for tuberculosis of the spine-A comparison between ambulant treatment and radical surgery-Ten year report.J Bone Joint Surge(Br),1999,81:467-471.
36. Sundararaj GD,Behera S,Raviv,et al.Role of posterior stabilization in the management of tuberculosis of the dorsal and lumbar spine.J Bone Joint Surg(Br) 2003;85-B:100-106.
1.胥少汀,葛宝丰,徐印坎主编.实用骨科学,第三版:1254-1283.
2. Medical Research Council.A 10-year assessment of a controlled trial comparing debridement and anterior spinal fusion in the management of tuberculosis of the spine in patients on standard chemotherapy in HongKong.Eighth report of the Medical Research Council Working Party on Tuberculosis of the Spine.J Bone Joint Surg Br,1982;64:393-398.
3. Medical Research Council.A 10-year assessment of controlled trials of inpatient and outpatient treatment of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy.Studies in Masan and Pusan,Korea.Ninth report of the Medical Research Council Working Party on Tuberculosis of the Spine.J Bone Joint Surg Br,1985;67:103-110.
4. Rajasekaran S,Shanmugasundaram TK.Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis.J Bone Joint Surg,1989;71A:1314-1323.
5. Pomerantz M,Brown J.The surgical management of tuberculosis.Semin Thorac Cardiovasc Surg,1995;7:108-111.
6. Rajasekaran S.The natural history of post-tubercular hypnosis in children.Radiological signs which predict late increase in deformity.Bone Joint Surg Br,2001,83:954.
7.方先之.骨关节结核病灶清除疗法(941例临床报告).中华外科杂志,1957,5:90.
8.贾连顺.脊柱结核外科治疗的几个问题.中华骨科杂志, 2007,27(9):641.
9. Ito H,Tsuchija J,Asami g.A new radical operation for Pott’s disease,J Bone Joint Surg,1943,16:449.
10. Hodgson AR,Stock FE.Anterior spinal fusion.A preliminary Communication on the radical treatment of Pott’s disease and Pott’s paraplegia.Br J Surg,1956,44: 266-275.
11.袁士琴.脊柱结核术后复发原因的探讨.中华结核和呼吸杂志,1986,9(1):67.
12.曾志远,潘文誉,曾荣东,等.脊柱结核诊治不当的原因分析.中国脊柱脊髓杂,2001,11(5):289-290.
13. Mehmet Turgut. Spinal tuberculosis (Pott’s disease):its clinical presentation, surgical management,and outcome.A survey study on 694 patients.Neurosurg Rev,2001,24:8-13.
14. Khoo Larry T,Mikawa Kevin,FesslerRichard G.A surgical revisitation of Pott distemperofthespine.Spine,2003,3(2):130-145.
15. Hodgson AR,Stock FE.Anterior spinal fusion.A preliminary Communication on the radical treatment of Pott’s disease and Pott’s paraplegia.BrJ Surg,1956,44: 266-275.
16.郑晨希,饶书诚,等.椎体钉在胸椎结核手术治疗中的应用.中华骨科杂志,1992,12(6):401.
17. Jain R,Sawhney S,Berry M.Computed tomography of vertebral tuberculosis: patterns of bone destruction.Clin Radiol,1993,47:196～1991.
18.葛建忠,王自立,秦世炳,等.脊柱结核分枝杆菌耐利福平基因检测的实验研究.中国脊柱脊髓杂志,2004,14(12):745-747.
19.金大地.再谈脊柱结核的外科治疗.中华外科杂志,2007,45(18):1225.
20. Rajasekaran S,Shanmugasundaram TK.Prediction of the angle of gibbusdefor- mity in tuberculosis of the spine.J Bone Join Surg(Am),1987,69: 503-509.
21. Lee EY,Hahn MS.A study of influences of the anteriorinterver-tebral fusion upon the correctability of Kyphosis in tuberculous spondylitis.J Korean Orthop Assoc,1968,3:31-40.
22. Kim BJ,Ko HS,Lim Y,et al.the clinical Study of the tuberculous spondylitis.J Korean Orthop Assoc,1993,28:2221-2232.
23.王自立,金卫东等,超短程化疗方案及病椎部分切除术治疗脊柱结核.中华骨科杂志,2005,25(2):81-85.
24. Moon MS,Kim I,Woo YK,et al.Consevative treatment of tuberculosis of the thoracic and lumber slts apine adund children.1987,11:315-322.
25. Moon MS,Woo YK,Lee KS,et al.Posterior instiumentation and anterior interbody fusion for tuberculosis kyphosis of dorsal and lumbar spine.Spine,1995,20(17): 1910-1916.
26. Yilmaz C,Selek H,Grkan I,et al.Anterior instrumentation for the treatment of spinal tuberculosis,J Bone Joint Surg(Am),1999,81(9):1261-1267.
27. Lee TC,Lu K,Yang LC,et al.Transpedicular instrumentation as an Adjunct in the treatment of thoracolumbar and lumbar tuberculosis with early stage bone destruction.Neurosurg.
28.金大地,陈建庭,张浩,等.一期前路椎间植骨内固定治疗胸腰椎结核.中华外科杂志,2000,38(12):900-902.
29. Oga M,Arizono T,Takasita M,et al.Evaluation of the risk of Instrumentation saa foreign body in spinal tuberculosis.Spinal,1993,18:1890-1894.
30.周劲松,陈建庭,等.结核分枝杆菌对材料粘附能力的体外实验研究.中国脊柱脊髓杂志,2003,13-11:670-673.
31.瞿东滨,等.手术治疗脊柱结核什么情况应用内固定.中国脊柱脊髓杂志,2004,14(12):712.
32.关晔等.手术治疗脊柱结核什么情况应用内固定.中国脊柱脊髓杂志,2004,14(12):714.
33.马远征等.手术治疗脊柱结核什么情况应用内固定.中国脊柱脊髓杂志,2004,14(12):715.
34. ?zdemir HM,kemal AU,Tun? ???n.The role of anterior spinal Instrumentation and allograft fibula for the treatment of pott disease.Spine 2003;28:474-479.
35. Al-Sebai MW,Al-Khawashki H,Al-Arabi K,et al.Operative treatment of progressive deformity in spinal tuberculosis.Int Orthop 2001;25:322-325.
36. Benli IT,Kis M,Akalin s,et al.The results of anterior radical debridement and anterior instrumentation in Pott disease and comparison with other surgical techniques.Kobe J Med Sci 2000,46:39-68.
37. Raraj AA.Anterior instrumentation for the treatment of spinaltuberculosis.J Bone Joint Surg Am 2001,83:463-464.
38. Govender S.The outcome of allografts and anterior instrumentation in spineal tuberculosis.Clin Othop 2002,398:60-66.
39. Govender S,Parbhoo AH,Kumar KPs,et al.Anterior spinal decompression in HIV-positive patients with tuberculosis.J Bone Joint Surg Br 2001;83: 864-867.
40.杨文宇,王自立,金卫东,等.脊柱结核手术切除病灶组织的病理学观察及切除范围探讨.宁夏医学院学报,2005,27(2):119-120.
41.尹若峰,费琦,王以朋.脊柱融合生物学特性及融合材料的选择.中华外科杂志,2006,44(12):856-858.
42.金大地.化疗和外科干预并重,进一步提高脊柱结核治疗水平.中华骨科杂志,2005,25(2):65-67.
43.施建党,金群华,金卫东.脊柱结核26例再手术原因分析[J].宁夏医学杂志,1999,21(4):229-230.
44. Turgut M.Spinal tuberculosis(Pott’S disease):its clinical present- ation,surgical management and outcome.A survey study on 694 patients [J].Neurosurg Rev, 2001,24(2):8-l3.
2. Ito H,Tsuchija J,Asami g.A new radical operation for Pott’s disease,J Bone Joint Surg,1943;16:449.
3. Hodgson AR,Stock FE.Anterior spinal fusion.A preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia.Br J Surg,1956;44: 266-275.
4.方先之.骨关节结核病灶清除疗法(941例临床报告).中华外科杂志,1957,5:90.
5. Rajasekaran s,soundarapandian S.Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis Bone Joint Surg(Am),1989,71:1314-1323.
6.李承球,脊柱结核的诊断与治疗进展.颈腰痛杂志,1999,18(3):1890-1894.
7. Rajasekaran S,Shanmugasundaram TK.Prediction of the angle of gibbus deformity in tuberculosis of the spine.J Bone Joint Surg(Am),1987,69:503-509.
8. Lee EY,Hahn MS.A study of influences of the anterior intervertebral fusion upon the correctability of Kyphosis in tuberculous spondylitis.J Korean Orthop Assoc,1968;3:31-40.
9. Kim BJ,Ko HS,Lim Y,et al.the clinical Study of the tuberculous spondylitis.J Korean Orthop Assoc,1993;28:2221-2232.
10.瞿东滨,金大地.脊柱结核的一期手术治疗.中华医学杂志,2003,83(2 )110-113.
11.王自立,杨文宇,等.病椎部分切除、取髂骨植骨及内固定术治疗脊柱结核.中国脊柱脊髓杂志,2004;14(12)718-719.
12. Cengiz Y,Hakan YS,IlksenG,et al.Anterior instrumentation for the treatment of spine tuberculosis.1999,J Bone and Joint Surg,18(A):1261-1267.
13. H Mustafa Ozdemir,A Kemal Us,Tunc Ogun. The role of anterior spine instrumentation and allograft fibula for the treatment of Patt disease. Spine, 2003,28(5):474-479.
14. Sundararaj GD,Behera S,Ravi V,et al.Role of posterior stabilization in the management of tuberculosis of the dorsal and lumber spine.J Bone JointSurg (Br),2003,85:100-105.
15. Mehta JS,Bhojraj.Tuberculosis of the thoracic spine.J Bone Joint Surg(Br), 2001,83:859-863.
16. MRC Working on Tuberculosis of Spine. Controlled trial of short-course regimens of chemotherapy in the ambulatory treatment of spine tuberculosis. JBone Joint Surg(Br),1993,75:240-248.
17. Parthasarathy R,Sriram K,Santhd T,et al.Short-course chemotherapy for tuberculosis of the spine.J Bone Joint Surg(Br),1999,81:464-471.
18. Moon Ms,Woo YK,Lee KS,et al.Posterior instrumentation and anterior interbody fusion for tuberculosis kyphosis of dorsal and lumbar spines. Spine, 1995, 20(17): 1910-1916.
19.王自立,金卫东,等.超短程化疗方案及病椎部分切除术治疗脊柱结核.中华骨科杂志,2005,25(2):81-85.
20. Moon MS,Kim I,Woo YK,et al.Consevative treatment of tuberculosis of the thoracic and lumber spine adults and children.1987,11:315-322.
21.金大地,陈建庭,张浩,等.一期前路椎间植骨病内固定治疗胸腰椎结核.中华外科杂志,2000,38:900～903.
22. Oga M ,Arizono T,Takasita M,et al.Evaluation of the risk of instrumentation sa a foreign body in spinal tuberculosis.Spinal.1993,18:1890-1894.
23.周劲松,陈建庭,等.结核分枝杆菌对材料粘附能力的体外实验研究.中国脊柱髓杂志,2003,13-11:670-673.
24.郑晨希,饶书诚,等.椎体钉在胸椎结核手术治疗中的应用.中华骨科杂志,1992,12(6):401.
25. Yilmaz C,Selek H,Grkan I,et al.Anterior instrumentation for the treatment of spinal tuberculosis,J Bone Joint Surg(Am),1999,81(9):1261-1267.
26. Lee TC,Lu K,Yang LC,et al.Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar tuberculosis with early stage bone destruction.Neurosurg.
27.瞿东滨,等.手术治疗脊柱结核什么情况应用内固定.中国脊柱脊髓杂志,2004,14(12):712.
28.关晔.手术治疗脊柱结核什么情况应用内固定.中国脊柱脊髓杂志, 2004,14(12):714.
29.马远征.手术治疗脊柱结核什么情况应用内固定.中国脊柱脊髓杂志,2004,14(12):715.
30. Yilmaz C,Hakan K,Gurkan I,et al.Anterior instrumentation for the treatment of spinal tuberculosis.J Bone Joint Surg(Am),1999,81:1261-1267.
31. ?zdemir HM,kemal AU,Tun? ???n.The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease.Spine 2003;28:474-479.
32. Al-Sebai MW,Al-Khawashki H,Al-Arabi K,et al.Operative treatment of progress- sive deformity in spinal tuberculosis. Int Orthop 2001;25:322-325.
33. Benli IT,Kis M,Akalin s,et al.The results of anterior radical debridement and anterior instrumentation in Pott disease and comparison with othersurgical techniques.Kobe J Med Sci 2000;46:39-68.
34. Raraj AA.Anterior instrumentation for the treatment of spinal tuberculosis.J Bone Joint Surg Am 2001;83:463-464.
35. Parthasarathy R,Sriram K,Santha T,et al. Short-course chemotherapy for tuberculosis of the spine-A comparison between ambulant treatment and radical surgery-Ten year report.J Bone Joint Surge(Br),1999,81:467-471.
36. Sundararaj GD,Behera S,Raviv,et al.Role of posterior stabilization in the management of tuberculosis of the dorsal and lumbar spine.J Bone Joint Surg(Br) 2003;85-B:100-106.
1.胥少汀,葛宝丰,徐印坎主编.实用骨科学,第三版:1254-1283.
2. Medical Research Council.A 10-year assessment of a controlled trial comparing debridement and anterior spinal fusion in the management of tuberculosis of the spine in patients on standard chemotherapy in HongKong.Eighth report of the Medical Research Council Working Party on Tuberculosis of the Spine.J Bone Joint Surg Br,1982;64:393-398.
3. Medical Research Council.A 10-year assessment of controlled trials of inpatient and outpatient treatment of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy.Studies in Masan and Pusan,Korea.Ninth report of the Medical Research Council Working Party on Tuberculosis of the Spine.J Bone Joint Surg Br,1985;67:103-110.
4. Rajasekaran S,Shanmugasundaram TK.Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis.J Bone Joint Surg,1989;71A:1314-1323.
5. Pomerantz M,Brown J.The surgical management of tuberculosis.Semin Thorac Cardiovasc Surg,1995;7:108-111.
6. Rajasekaran S.The natural history of post-tubercular hypnosis in children.Radiological signs which predict late increase in deformity.Bone Joint Surg Br,2001,83:954.
7.方先之.骨关节结核病灶清除疗法(941例临床报告).中华外科杂志,1957,5:90.
8.贾连顺.脊柱结核外科治疗的几个问题.中华骨科杂志, 2007,27(9):641.
9. Ito H,Tsuchija J,Asami g.A new radical operation for Pott’s disease,J Bone Joint Surg,1943,16:449.
10. Hodgson AR,Stock FE.Anterior spinal fusion.A preliminary Communication on the radical treatment of Pott’s disease and Pott’s paraplegia.Br J Surg,1956,44: 266-275.
11.袁士琴.脊柱结核术后复发原因的探讨.中华结核和呼吸杂志,1986,9(1):67.
12.曾志远,潘文誉,曾荣东,等.脊柱结核诊治不当的原因分析.中国脊柱脊髓杂,2001,11(5):289-290.
13. Mehmet Turgut. Spinal tuberculosis (Pott’s disease):its clinical presentation, surgical management,and outcome.A survey study on 694 patients.Neurosurg Rev,2001,24:8-13.
14. Khoo Larry T,Mikawa Kevin,FesslerRichard G.A surgical revisitation of Pott distemperofthespine.Spine,2003,3(2):130-145.
15. Hodgson AR,Stock FE.Anterior spinal fusion.A preliminary Communication on the radical treatment of Pott’s disease and Pott’s paraplegia.BrJ Surg,1956,44: 266-275.
16.郑晨希,饶书诚,等.椎体钉在胸椎结核手术治疗中的应用.中华骨科杂志,1992,12(6):401.
17. Jain R,Sawhney S,Berry M.Computed tomography of vertebral tuberculosis: patterns of bone destruction.Clin Radiol,1993,47:196～1991.
18.葛建忠,王自立,秦世炳,等.脊柱结核分枝杆菌耐利福平基因检测的实验研究.中国脊柱脊髓杂志,2004,14(12):745-747.
19.金大地.再谈脊柱结核的外科治疗.中华外科杂志,2007,45(18):1225.
20. Rajasekaran S,Shanmugasundaram TK.Prediction of the angle of gibbusdefor- mity in tuberculosis of the spine.J Bone Join Surg(Am),1987,69: 503-509.
21. Lee EY,Hahn MS.A study of influences of the anteriorinterver-tebral fusion upon the correctability of Kyphosis in tuberculous spondylitis.J Korean Orthop Assoc,1968,3:31-40.
22. Kim BJ,Ko HS,Lim Y,et al.the clinical Study of the tuberculous spondylitis.J Korean Orthop Assoc,1993,28:2221-2232.
23.王自立,金卫东等,超短程化疗方案及病椎部分切除术治疗脊柱结核.中华骨科杂志,2005,25(2):81-85.
24. Moon MS,Kim I,Woo YK,et al.Consevative treatment of tuberculosis of the thoracic and lumber slts apine adund children.1987,11:315-322.
25. Moon MS,Woo YK,Lee KS,et al.Posterior instiumentation and anterior interbody fusion for tuberculosis kyphosis of dorsal and lumbar spine.Spine,1995,20(17): 1910-1916.
26. Yilmaz C,Selek H,Grkan I,et al.Anterior instrumentation for the treatment of spinal tuberculosis,J Bone Joint Surg(Am),1999,81(9):1261-1267.
27. Lee TC,Lu K,Yang LC,et al.Transpedicular instrumentation as an Adjunct in the treatment of thoracolumbar and lumbar tuberculosis with early stage bone destruction.Neurosurg.
28.金大地,陈建庭,张浩,等.一期前路椎间植骨内固定治疗胸腰椎结核.中华外科杂志,2000,38(12):900-902.
29. Oga M,Arizono T,Takasita M,et al.Evaluation of the risk of Instrumentation saa foreign body in spinal tuberculosis.Spinal,1993,18:1890-1894.
30.周劲松,陈建庭,等.结核分枝杆菌对材料粘附能力的体外实验研究.中国脊柱脊髓杂志,2003,13-11:670-673.
31.瞿东滨,等.手术治疗脊柱结核什么情况应用内固定.中国脊柱脊髓杂志,2004,14(12):712.
32.关晔等.手术治疗脊柱结核什么情况应用内固定.中国脊柱脊髓杂志,2004,14(12):714.
33.马远征等.手术治疗脊柱结核什么情况应用内固定.中国脊柱脊髓杂志,2004,14(12):715.
34. ?zdemir HM,kemal AU,Tun? ???n.The role of anterior spinal Instrumentation and allograft fibula for the treatment of pott disease.Spine 2003;28:474-479.
35. Al-Sebai MW,Al-Khawashki H,Al-Arabi K,et al.Operative treatment of progressive deformity in spinal tuberculosis.Int Orthop 2001;25:322-325.
36. Benli IT,Kis M,Akalin s,et al.The results of anterior radical debridement and anterior instrumentation in Pott disease and comparison with other surgical techniques.Kobe J Med Sci 2000,46:39-68.
37. Raraj AA.Anterior instrumentation for the treatment of spinaltuberculosis.J Bone Joint Surg Am 2001,83:463-464.
38. Govender S.The outcome of allografts and anterior instrumentation in spineal tuberculosis.Clin Othop 2002,398:60-66.
39. Govender S,Parbhoo AH,Kumar KPs,et al.Anterior spinal decompression in HIV-positive patients with tuberculosis.J Bone Joint Surg Br 2001;83: 864-867.
40.杨文宇,王自立,金卫东,等.脊柱结核手术切除病灶组织的病理学观察及切除范围探讨.宁夏医学院学报,2005,27(2):119-120.
41.尹若峰,费琦,王以朋.脊柱融合生物学特性及融合材料的选择.中华外科杂志,2006,44(12):856-858.
42.金大地.化疗和外科干预并重,进一步提高脊柱结核治疗水平.中华骨科杂志,2005,25(2):65-67.
43.施建党,金群华,金卫东.脊柱结核26例再手术原因分析[J].宁夏医学杂志,1999,21(4):229-230.
44. Turgut M.Spinal tuberculosis(Pott’S disease):its clinical present- ation,surgical management and outcome.A survey study on 694 patients [J].Neurosurg Rev, 2001,24(2):8-l3.