前、后路结核病灶清除、植骨融合、矫形内固定治疗胸腰椎结核的临床研究
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摘要
研究背景
脊柱结核是最常见肺外结核，占骨与关节结核的1/3-1/2，脊柱结核多发于胸腰椎，病情严重者可导致神经功能障碍、后凸畸形、甚至截瘫。在有效的使用抗结核药物化疗的基础上配合早期积极的结核病灶清除及内固定术可以有效控制病情，重建脊柱稳定性，缩短治疗周期，减少伤残，提高患者生活质量
目前对胸腰椎结核手术治疗常规方法是前路经胸腔，腹腔或胸膜外、腹膜后入路行病灶清除、植骨融合及内固定术。前路手术治疗胸腰椎结核已取得明显疗效，但是在近20年期间，脊柱结核的治疗有了显著的发展。诊断工具与技术的提高使脊柱结核早期诊断成为可能，脊柱内固定系统的发展特别是后路椎弓根螺钉系统的出现提高了结核的治愈率，而手术技术的发展使后路结核病灶清除及内固定融合术治疗胸腰椎结核成为一种趋势，但由于后路结核病灶清除及内固定融合术治疗胸腰椎结核时需切除部分正常的脊柱后柱结构及可能导致将前路病灶区结核菌引入到后柱结构或椎管内而存在争议。
目的
1探讨后路结核病灶清除、植骨融合、矫形内固定术治疗胸腰椎结核的临床疗效并与前路病灶清除、植骨融合内固定术相比较；
2通过对术区病原学进行检测来探讨前、后路病灶清除、植骨融合内固定术的术区病原学的异同；
3通过有限元的方法来比较前路钉板固定系统与后路椎弓根螺钉固定系统应用于胸腰椎固定的生物力学稳定性。
方法
1.回顾性分析2004年1月到2010年12月收治的胸腰椎结核患者，其中后路手术组(A组)41例，年龄14-76岁，平均38±14.8岁，其中男20例，女21例，其中伴有脊柱后凸畸形16例（Cobb’s角5.4°-47.1°，平均23°±9.9°），有神经功能障碍者17例，1例按ASIA分级C级，1其余均为D级。所有病例均行后路病灶清除、植骨融合及矫形内固定术；前路手术组（B组）50例，年龄14-68岁，平均33±11.3岁，其中男18例，女32例，伴有后凸畸形者20例（11°-82°，平均28.1°±15.2°），有神经功能障碍者20例，2例按ASIA分级为C级，1例B级，其余为D级，所有病例均行经前路结核病灶清除、植骨融合、矫形内固定术。对两组患者术前后的ASIA分级，手术时间，出血量、住院时间、后凸角，术中及术后并发症、骨性融合及结核复发等方面进行比较分析。
2.术后48h,96h,7d收集患者术区的引流液，应用PCR检测技术进行检测，同时对96h术区引流液采用结核基因芯片技术、快速培养+罗氏培养技术进行病原学检测，了解前后路手术后术区病原学的差别。
3.应用MIMICS软件重建前后固定模型，然后用ANASYS软件应用有限元分析方法对胸腰椎前后路固定器械进行生物力学分析，比较前、后路内固定系统的应力分布及生物力学稳定性。
结果
1.后路手术组与前路手术组在手术时间、出血量、住院时间无明显统计学差异，p＞0.05；术前两组存在畸形患者的Cobb’s角均数比较无明显统计学差异，但术后后路手术组在畸形矫正上明显优于前路手术组，p＜0.05；在畸形矫正丢失率上两组间无差异， p＞0.05。并发症发生率后路手术组明显少于前路手术组，p＜0.05。两组有神经功能障碍患者术后恢复满意。
2.前路与后路手术组患者术区结核菌检出阳性率48h PCR21.4%，22.2%,96h PCR28.6%,25.9%.7d14.2%,3.7%.快培+罗氏培养:96h7.1%,7.4%。MTD:96h:21.4%,0%。PCR与培养前后路手术组比较无明显统计学意义，P＞0.05。MTD检测两组有明显统计学意义，p＜0.05。两组检测结果总阳性率比较无明显统计学意义, P＞0.05。
3.在前屈、后伸及旋转载荷下后路椎弓根螺钉系统固定椎体的位移峰值小于前路钉板系统。在侧屈状态时前路钉板系统的固定椎体位移峰值小地后路椎弓根螺钉系统。前路内固定系统中钛笼、螺钉在旋转载荷时应力峰值最大，钛板在后伸载荷应力峰值最大，而钛笼、钛板在后伸载荷时位移峰值最大，螺钉在旋转载荷时位移峰值最大，后路椎弓根螺钉系统中钛笼、螺钉、钛棒在旋转载荷时应力峰值最大，而钛笼、螺钉在侧弯时位移峰值最大，钛棒在前屈时位移峰值最大。
结论
后路病灶清除、植骨融合内固定术与前路病灶清除、植骨融合内固定术治疗胸腰椎结核均可取得良好的临床疗效，后路病灶清除、植骨融合内固定术在胸腰椎结核后凸畸形矫正率上明显优于前路手术，后路手术与前路手相比具有切口小，残留瘢痕少，创伤小，适用范围广等优点；从病原学检测比较证实前路与后路病灶清除、植骨融合内固定术术区残留病原菌是无差异的，因而前路与后路结核病灶清除均可达到彻底清除病灶的目的；在前屈、后伸及旋转载荷下后路椎弓根螺钉系统固定胸腰椎的稳定性优于前路钉板系统，而在侧屈状态时，前路钉板系统固定胸腰椎的稳定性则优于后路椎弓根螺钉系统，而在不同的负荷状态时两种固定系统的的应力分布不同和，然而两种固定系统应用于胸腰椎结核均可达到重建脊柱稳定性，提高结核的治疗效果。
Background
Spinal tuberculosis, which is the most common form of extrapulmonary tuberculosis,frequently damages the thoracolumbar segments. Severe thoracolumbar tuberculosis canresult in neurological deficits, gibbosity and even paraplegia. Surgical debridement withinstrumentations based on the potent ant-tubercular chemotherapy plays an important rolein the treatment of spinal tuberculosis. This approach can provide stabilization and preventor correct kyphotic deformity.
Anterior radical excision has been used to achieve favorable clinical outcomes inpatients with thoracic and lumbar tuberculosis. With the development of instrumentationsand techniques, the posterior approach combined with debridement, autogenous bonegrafting and instrumentations for the thoracic and lumbar tuberculosis is gaining acceptance.However, the posterior approach for the treatment of thoracic and lumbar tuberculosis isstill controversial.
Objective
1. To explore the clinical outcomes of anterior or posterior approach combined withdebridement，bone grafting and instrumentations for thoracic and lumbar tuberculosis viacomparison of the two different approachs.
2. To investigate the etiological difference of tubercle bacillus in the operative area ofanterior and posterior approach by means of PCR (polymerase chain reaction), MTD(mycobacterium tuberculosis DNA chip test) and bacterial culture.
3. To evaluate the biomechanical difference of anterior screw-plate system andposterior pedicle-screw system by means of FEM (finite element method).
Methods
1. Ninety-one cases with thoracic and lumbar tuberculosis between January2004andDecember2010were reviewed retrospectively. Forty-one cases (20males and21females) underwent posterior approach combined with debridement, bone grafting andpedicle-screws system, whose average age was38±14.8years (range,14-76years),16cases with kyphosis deformity and17cases with neurological deficit. Fifty cases underwentanterior approach combined with debridement, bone grafting and anterior instrumentationsystem, including18males and32females, whose average age was33±11.3years (range,14-76years),20cases with kyphosis deformity and20cases with neurological deficit. Theassessment standards include the items of operation time, intraoperative blood loss, bonefusion, intra and postoperative complications, the ASIA (American Spinal InjuryAssociation) score and Cobb’s angle.
2. Drainage liquid collected at postoperative48h,96h, and7d was examined by PCR,MTD and bacterial culture to explore the difference of tubercle bacillus in operative area.
3. FEM was used to investigate the biomechanical difference of anterior screw-platesystem and posterior pedicle-screw system.
Result
1. There was no statistical difference in duration of operation, blood loss, time inhospital between two groups (p＞0.05), there was no statistical difference in thepreoperative Cobb’s angle of patients with kyphosis deformity in both groups. However,there was significantly statistical difference in the postoperative Cobb’s angle of patients inboth group, while at the final follow-up, the data of Cobb’s angel did not differ statistically.The neurological status of the patients improved from B to E according to ASIA score.
2. The positive rate of tubercle bacillus in two groups was35%and37%respectively,and there was no significantly statistical difference between two groups.
3. In the status of bending, extending and rotating, the stability of vertebra withposterior instrumentations was better than the anterior, on the contrary, in the lateralbending situation, compared with the anterior, the stability of vertebra with posteriorinstrumentations was weaker.
In the situation of rotating, stress value of screws and titanium cage in anteriorscrew-plate system was maximal, while in the extending situation, stress value of plate inanterior instrumentations was maximal and the displacement values of titanium cage andplate were maximal. In the rotating situation, displacement value of screws wass maximal.
In the situation of rotating, stress value of rods, screws and titanium cage in posterior pedicle screw system was maximal. In the situation of bending, the displacement values oftitanium cage and screws were maximal, while in flexion, the displacement value of rodswas maximal.
Conclusion
Good clinical outcomes were achieved in both of the anterior approach and posteriorapproach combined with debridement, bone grafting and instrumentations for thoracic andlumbar tuberculosis. However, the effect of correction deformity of posterior approach wasbetter than anterior approach, The advantages of posterior approach combined withdebridement, bone grafting and pedicle screws were limited trauma, unobvious scar and soon. Posterior approach combined with debridement, bone grafting and instrumentations forthoracic and lumbar tuberculosis was proved to be safety by means of etiology methods andto be stabilized for spine by FEM.
脊柱结核是最常见肺外结核，占骨与关节结核的1/3-1/2，脊柱结核多发于胸腰椎，病情严重者可导致神经功能障碍、后凸畸形、甚至截瘫。在有效的使用抗结核药物化疗的基础上配合早期积极的结核病灶清除及内固定术可以有效控制病情，重建脊柱稳定性，缩短治疗周期，减少伤残，提高患者生活质量
目前对胸腰椎结核手术治疗常规方法是前路经胸腔，腹腔或胸膜外、腹膜后入路行病灶清除、植骨融合及内固定术。前路手术治疗胸腰椎结核已取得明显疗效，但是在近20年期间，脊柱结核的治疗有了显著的发展。诊断工具与技术的提高使脊柱结核早期诊断成为可能，脊柱内固定系统的发展特别是后路椎弓根螺钉系统的出现提高了结核的治愈率，而手术技术的发展使后路结核病灶清除及内固定融合术治疗胸腰椎结核成为一种趋势，但由于后路结核病灶清除及内固定融合术治疗胸腰椎结核时需切除部分正常的脊柱后柱结构及可能导致将前路病灶区结核菌引入到后柱结构或椎管内而存在争议。
目的
1探讨后路结核病灶清除、植骨融合、矫形内固定术治疗胸腰椎结核的临床疗效并与前路病灶清除、植骨融合内固定术相比较；
2通过对术区病原学进行检测来探讨前、后路病灶清除、植骨融合内固定术的术区病原学的异同；
3通过有限元的方法来比较前路钉板固定系统与后路椎弓根螺钉固定系统应用于胸腰椎固定的生物力学稳定性。
方法
1.回顾性分析2004年1月到2010年12月收治的胸腰椎结核患者，其中后路手术组(A组)41例，年龄14-76岁，平均38±14.8岁，其中男20例，女21例，其中伴有脊柱后凸畸形16例（Cobb’s角5.4°-47.1°，平均23°±9.9°），有神经功能障碍者17例，1例按ASIA分级C级，1其余均为D级。所有病例均行后路病灶清除、植骨融合及矫形内固定术；前路手术组（B组）50例，年龄14-68岁，平均33±11.3岁，其中男18例，女32例，伴有后凸畸形者20例（11°-82°，平均28.1°±15.2°），有神经功能障碍者20例，2例按ASIA分级为C级，1例B级，其余为D级，所有病例均行经前路结核病灶清除、植骨融合、矫形内固定术。对两组患者术前后的ASIA分级，手术时间，出血量、住院时间、后凸角，术中及术后并发症、骨性融合及结核复发等方面进行比较分析。
2.术后48h,96h,7d收集患者术区的引流液，应用PCR检测技术进行检测，同时对96h术区引流液采用结核基因芯片技术、快速培养+罗氏培养技术进行病原学检测，了解前后路手术后术区病原学的差别。
3.应用MIMICS软件重建前后固定模型，然后用ANASYS软件应用有限元分析方法对胸腰椎前后路固定器械进行生物力学分析，比较前、后路内固定系统的应力分布及生物力学稳定性。
结果
1.后路手术组与前路手术组在手术时间、出血量、住院时间无明显统计学差异，p＞0.05；术前两组存在畸形患者的Cobb’s角均数比较无明显统计学差异，但术后后路手术组在畸形矫正上明显优于前路手术组，p＜0.05；在畸形矫正丢失率上两组间无差异， p＞0.05。并发症发生率后路手术组明显少于前路手术组，p＜0.05。两组有神经功能障碍患者术后恢复满意。
2.前路与后路手术组患者术区结核菌检出阳性率48h PCR21.4%，22.2%,96h PCR28.6%,25.9%.7d14.2%,3.7%.快培+罗氏培养:96h7.1%,7.4%。MTD:96h:21.4%,0%。PCR与培养前后路手术组比较无明显统计学意义，P＞0.05。MTD检测两组有明显统计学意义，p＜0.05。两组检测结果总阳性率比较无明显统计学意义, P＞0.05。
3.在前屈、后伸及旋转载荷下后路椎弓根螺钉系统固定椎体的位移峰值小于前路钉板系统。在侧屈状态时前路钉板系统的固定椎体位移峰值小地后路椎弓根螺钉系统。前路内固定系统中钛笼、螺钉在旋转载荷时应力峰值最大，钛板在后伸载荷应力峰值最大，而钛笼、钛板在后伸载荷时位移峰值最大，螺钉在旋转载荷时位移峰值最大，后路椎弓根螺钉系统中钛笼、螺钉、钛棒在旋转载荷时应力峰值最大，而钛笼、螺钉在侧弯时位移峰值最大，钛棒在前屈时位移峰值最大。
结论
后路病灶清除、植骨融合内固定术与前路病灶清除、植骨融合内固定术治疗胸腰椎结核均可取得良好的临床疗效，后路病灶清除、植骨融合内固定术在胸腰椎结核后凸畸形矫正率上明显优于前路手术，后路手术与前路手相比具有切口小，残留瘢痕少，创伤小，适用范围广等优点；从病原学检测比较证实前路与后路病灶清除、植骨融合内固定术术区残留病原菌是无差异的，因而前路与后路结核病灶清除均可达到彻底清除病灶的目的；在前屈、后伸及旋转载荷下后路椎弓根螺钉系统固定胸腰椎的稳定性优于前路钉板系统，而在侧屈状态时，前路钉板系统固定胸腰椎的稳定性则优于后路椎弓根螺钉系统，而在不同的负荷状态时两种固定系统的的应力分布不同和，然而两种固定系统应用于胸腰椎结核均可达到重建脊柱稳定性，提高结核的治疗效果。
Background
Spinal tuberculosis, which is the most common form of extrapulmonary tuberculosis,frequently damages the thoracolumbar segments. Severe thoracolumbar tuberculosis canresult in neurological deficits, gibbosity and even paraplegia. Surgical debridement withinstrumentations based on the potent ant-tubercular chemotherapy plays an important rolein the treatment of spinal tuberculosis. This approach can provide stabilization and preventor correct kyphotic deformity.
Anterior radical excision has been used to achieve favorable clinical outcomes inpatients with thoracic and lumbar tuberculosis. With the development of instrumentationsand techniques, the posterior approach combined with debridement, autogenous bonegrafting and instrumentations for the thoracic and lumbar tuberculosis is gaining acceptance.However, the posterior approach for the treatment of thoracic and lumbar tuberculosis isstill controversial.
Objective
1. To explore the clinical outcomes of anterior or posterior approach combined withdebridement，bone grafting and instrumentations for thoracic and lumbar tuberculosis viacomparison of the two different approachs.
2. To investigate the etiological difference of tubercle bacillus in the operative area ofanterior and posterior approach by means of PCR (polymerase chain reaction), MTD(mycobacterium tuberculosis DNA chip test) and bacterial culture.
3. To evaluate the biomechanical difference of anterior screw-plate system andposterior pedicle-screw system by means of FEM (finite element method).
Methods
1. Ninety-one cases with thoracic and lumbar tuberculosis between January2004andDecember2010were reviewed retrospectively. Forty-one cases (20males and21females) underwent posterior approach combined with debridement, bone grafting andpedicle-screws system, whose average age was38±14.8years (range,14-76years),16cases with kyphosis deformity and17cases with neurological deficit. Fifty cases underwentanterior approach combined with debridement, bone grafting and anterior instrumentationsystem, including18males and32females, whose average age was33±11.3years (range,14-76years),20cases with kyphosis deformity and20cases with neurological deficit. Theassessment standards include the items of operation time, intraoperative blood loss, bonefusion, intra and postoperative complications, the ASIA (American Spinal InjuryAssociation) score and Cobb’s angle.
2. Drainage liquid collected at postoperative48h,96h, and7d was examined by PCR,MTD and bacterial culture to explore the difference of tubercle bacillus in operative area.
3. FEM was used to investigate the biomechanical difference of anterior screw-platesystem and posterior pedicle-screw system.
Result
1. There was no statistical difference in duration of operation, blood loss, time inhospital between two groups (p＞0.05), there was no statistical difference in thepreoperative Cobb’s angle of patients with kyphosis deformity in both groups. However,there was significantly statistical difference in the postoperative Cobb’s angle of patients inboth group, while at the final follow-up, the data of Cobb’s angel did not differ statistically.The neurological status of the patients improved from B to E according to ASIA score.
2. The positive rate of tubercle bacillus in two groups was35%and37%respectively,and there was no significantly statistical difference between two groups.
3. In the status of bending, extending and rotating, the stability of vertebra withposterior instrumentations was better than the anterior, on the contrary, in the lateralbending situation, compared with the anterior, the stability of vertebra with posteriorinstrumentations was weaker.
In the situation of rotating, stress value of screws and titanium cage in anteriorscrew-plate system was maximal, while in the extending situation, stress value of plate inanterior instrumentations was maximal and the displacement values of titanium cage andplate were maximal. In the rotating situation, displacement value of screws wass maximal.
In the situation of rotating, stress value of rods, screws and titanium cage in posterior pedicle screw system was maximal. In the situation of bending, the displacement values oftitanium cage and screws were maximal, while in flexion, the displacement value of rodswas maximal.
Conclusion
Good clinical outcomes were achieved in both of the anterior approach and posteriorapproach combined with debridement, bone grafting and instrumentations for thoracic andlumbar tuberculosis. However, the effect of correction deformity of posterior approach wasbetter than anterior approach, The advantages of posterior approach combined withdebridement, bone grafting and pedicle screws were limited trauma, unobvious scar and soon. Posterior approach combined with debridement, bone grafting and instrumentations forthoracic and lumbar tuberculosis was proved to be safety by means of etiology methods andto be stabilized for spine by FEM.
引文
1. Annabel Baddeley HMD, Dennis Falzon (2011) Global tuberculosis controll2011WorldHealth Organization http://www.who.int/about/licensing/copyright_form/en/index.html
2.方先之(1957)骨关节结核病灶清除疗法北京人民卫生出版社
3. Guven, Kumano O, Yalcin K, Karahan S, Tsuji M, S.(1976): A single stage posteriorapproach and rigid fixation for preventing kyphosis in the treatment of spinaltuberculosis.: Spine19(9):1039-1043
4. Fukuta, Miyamoto S, Masuda K, Hosoe T, Kodama H, Nishimoto H, Sakaeda H,Shimizu H, K.(1976): Two-stage (posterior and anterior) surgical treatment usingposterior spinal instrumentation for pyogenic and tuberculotic spondylitis.: Spine28(15):E302-308
5. Jain, Dhammi AK, Prashad IK, Sinha B, Mishra S, P.(2008): Simultaneous anteriordecompression and posterior instrumentation of the tuberculous spine using ananterolateral extrapleural approach.: J Bone Joint Surg Br90(11):1477-1481
6. Lee SH, Sung JK, Park YM (2006) Single-stage transpedicular decompression andposterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis:a retrospective case series. J Spinal Disord Tech19(8):595-602. doi:10.1097/01.bsd.0000211241.06588.7b00024720-200612000-00010[pii]
7. Tuli, S M (2007): Tuberculosis of the spine: a historical review.: Clin Orthop Relat Res460:29-38
8. Jain, A K (2007): Tuberculosis of the spine.: Clin Orthop Relat Res460:2-3
9.许建中(2006)对脊柱结核手术指征和手术方式的再认识.中国脊柱脊髓杂志16(12):889-890
10. Hodgson, A-R S, F-E F, H-S ONG, G B (1960): Anterior spinal fusion. The operativeapproach and pathological findings in412patients with Pott's disease of the spine.: BrJ Surg48:172-178
11. Stock, F E (1969): Anterior spinal fusion.1. A radical approach to the treatment oftuberculous disease of the spine.: Nurs Times65(17):532-534
12. Lougheed, J-C W, W G (1960): Anterior dependent drainage for tuberculouslumbosacral spinal lesions. Coccygectomy and dependent drainage in treatment oftuberculous lesions of the lower spine with associated soft-tissue abscesses.: Arch Surg81:961-964
13. Mitchell, R M (1966): Anterior spinal fusion in spinal tuberculosis using an iliac boneblock.: East Afr Med J43(4):119-122
14. Cameron, J-A R, C-L R, D E (1962): The radical treatment of Pott's disease and Pott'sparaplegia by extirpation of the diseased area and anterior spinal fusion.: Am RevRespir Dis86:76-80
15. Oishi, S O, Y I, A K, T Y, T I, O K, M.(1964):[Radical Surgery of Spinal Tuberculosiswith Anterior Spinal Fusion.].: Nippon Seikeigeka Gakkai Zasshi38:564-565
16. Khan, M A (1964): The place of anterior spinal fusion in treatment of tuberculosis ofthe spine.: Clin Orthop Relat Res35:139-149
17. Tangco, Rivera AF, Silao MT, Awitan JVJ, A P, Jr.(1966): Approaches in anterior spinalfusion.: Philipp J Surg Surg Spec21(3):155-159
18. Stock, F E (1969): Anterior spinal fusion.2. A radical approach to the treatment oftuberculous disease of the spine.: Nurs Times65(18):564-566
19. Kim, Yun DJ, Moon YH, Riew SH, K D (1976): Posterior instrumentation usingcompressive laminar hooks and anterior interbody arthrodesis for the treatment oftuberculosis of the lower lumbar spine.: Spine29(13):E275-279
20. Benli, Kis IT, Akalin M, Citak S, Kanevetci M, Duman S, E.(2000): The results ofanterior radical debridement and anterior instrumentation in Pott's disease andcomparison with other surgical techniques.: Kobe J Med Sci46(1-2):39-68
21. Oga, Arizono M, Takasita T, Sugioka M, Y.(1976): Evaluation of the risk ofinstrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study.:Spine18(13):1890-1894
22. Ha KY, Chung YG, Ryoo SJ (2005) Adherence and biofilm formation of Staphylococcusepidermidis and Mycobacterium tuberculosis on various spinal implants. Spine (PhilaPa1976)30(1):38-43
23.Hirakawa, Miyamoto A, Masuda K, Fukuta T, Hosoe S, Iinuma H, Iwai N, Nishimoto C,Shimizu H, K.: Surgical outcome of2-stage (posterior and anterior) surgical treatmentusing spinal instrumentation for tuberculous spondylitis.: J Spinal Disord Tech23(2):133-138
24. Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posteriorinstrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal andlumbar spines. Spine (Phila Pa1976)20(17):1910-1916
25. Klockner, Valencia C, R.(1976): Sagittal alignment after anterior debridement andfusion with or without additional posterior instrumentation in the treatment of pyogenicand tuberculous spondylodiscitis.: Spine28(10):1036-1042
26. MS M, YK W, KS L, KY H, SS K, DH S (1976)-Posterior instrumentation and anteriorinterbody fusion for tuberculous kyphosis. Spine20(17):1910-1916
27. Guven O (1996) Posterior instrumentation and anterior interbody fusion for tuberculouskyphosis of dorsal and lumbar spines. Spine (Phila Pa1976)21(15):1840-1841
28. Laheri, Badhe VJ, Dewnany NP, G T (2001): Single stage decompression, anteriorinterbody fusion and posterior instrumentation for tuberculous kyphosis of thedorso-lumbar spine.: Spinal Cord39(8):429-436
29. Mukhtar, Farghaly AM, Ahmed MM, S H (2003): Surgical treatment of thoracic andlumbar tuberculosis by anterior interbody fusion and posterior instrumentation.: MedPrinc Pract12(2):92-96
30. Talu, Gogus U, Ozturk A, Hamzaoglu C, Domanic A, U.(2006): The role of posteriorinstrumentation and fusion after anterior radical debridement and fusion in the surgicaltreatment of spinal tuberculosis: experience of127cases.: J Spinal Disord Tech19(8):554-559
31. Gu, Cheng XF, Zhou L, Y Y (2009):[Radical debridement and single stage posteriorspinal fusion and instrumentation for the treatment of thoracic-lumber tuberculosis].:Zhonghua Yi Xue Za Zhi89(41):2898-2901
32. Xu, Yang YG, Liu YD, S L (2009):[Effect of surgical treatment for thoracolumbarspinal tuberculosis by anterior radical debridement with bone graft fusion and posteriorpedicle screw-rods system fixation].: Zhongguo Gu Shang22(12):938-940
33. Sundararaj, G D (2009): Simultaneous anterior decompression and posteriorinstrumentation of the tuberculous spine using an anterolateral extrapleural approach.:J Bone Joint Surg Br91(5):702-703
34. Oga M, Arizono T, Takasita M, Sugioka Y (1993) Evaluation of the risk ofinstrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study.Spine (Phila Pa1976)18(13):1890-1894
35. Yilmaz, Selek C, Gurkan HY, Erdemli I, Korkusuz B, Z.(1999): Anteriorinstrumentation for the treatment of spinal tuberculosis.: J Bone Joint Surg Am81(9):1261-1267
36. Benli, Kaya IT, Acaroglu A, E.(2007): Anterior instrumentation in tuberculousspondylitis: is it effective and safe?: Clin Orthop Relat Res460:108-116
37. Obaid-ur-Rahman A, Hussain S, T.(2009): Anterior surgical interventions in spinaltuberculosis.: J Coll Physicians Surg Pak19(8):500-505
38. Jin, Chen D, Zhang J, Zhai H, Wang D, Jiang J, J.(2000):[Anterior interbodyautografting and internal fixation for primary surgical management of thoracolumbarspinal tuberculosis].: Zhonghua Wai Ke Za Zhi38(12):900-902
39. Jin, Qu D, Chen D, Zhang J, H.(2004): One-stage anterior interbody autografting andinstrumentation in primary surgical management of thoracolumbar spinal tuberculosis.:Eur Spine J13(2):114-121
40. Christodoulou, Givissis AG, Karataglis P, Symeonidis D, Pournaras PD, J.(2006):Treatment of tuberculous spondylitis with anterior stabilization and titanium cage.:Clin Orthop Relat Res444:60-65
41.郭立新，马远征，陈兴等.(2008)脊柱结核的外科治疗与术后疗效评估.中华骨科杂志28(12):979-982
42.丁江平，翁习生，王斌等(2007)经脊柱前路病灶清除植骨一期前路内固定术治疗脊柱结核.中华骨科杂志27(1):54-58
43.许建中，张泽华，周强等(2006)一期前路病灶清除植骨融合内固定治疗腰骶椎结核.中国脊柱脊髓杂志16(12):897-900
44. Garst, R J (1992): Tuberculosis of the spine: a review of236operated cases in anunderdeveloped region from1954to1964.: J Spinal Disord5(3):286-300
45. Guven O, Kumano K, Yalcin S, Karahan M, Tsuji S (1994) A single stage posteriorapproach and rigid fixation for preventing kyphosis in the treatment of spinaltuberculosis. Spine (Phila Pa1976)19(9):1039-1043
46.姜传杰，杨永军，谭远超等(2010)一期后路病灶清除椎体钉内固定治疗中上胸椎结核.中国脊柱脊髓杂志20(4):326-330
47.李祥炎，徐皓，姚晓东等(2010)后路Ⅰ期病灶清除植骨内固定治疗胸椎、胸腰段脊柱结核.中国骨科临床与基础研究杂志2(1):21-24
48.盛伟斌，华强，曹力等(2005)一期后路病灶清除、楔形截骨矫形治疗胸腰椎结核并后凸或侧后凸畸形.中华外科杂志43(4):205-209
49.王锡阳，魏伟强，李伟伟等(2009)一期后路病灶清除、植骨融合内固定术治疗胸腰椎结核.中国脊柱脊髓杂志19(11):813-817
50.章文杰，洪正华，陈海啸等(2010)1期后路经椎弓根病灶清除及后路内固定治疗胸腰椎结核.浙江创伤外科15(3):289-290
51. Pu X, Zhou Q, He Q, Dai F, Xu J, Zhang Z, Branko K (2012) A posterior versus anteriorsurgical approach in combination with debridement, interbody autografting andinstrumentation for thoracic and lumbar tuberculosis. Int Orthop36(2):307-313.doi:10.1007/s00264-011-1329-0
1. Hodgson, A-R S, F-E F, H-S ONG, G B (1960): Anterior spinal fusion. The operativeapproach and pathological findings in412patients with Pott's disease of the spine.: BrJ Surg48:172-178
2. Benli, Kaya IT, Acaroglu A, E.(2007): Anterior instrumentation in tuberculousspondylitis: is it effective and safe?: Clin Orthop Relat Res460:108-116
3. Govender, S.(2002): The outcome of allografts and anterior instrumentation in spinaltuberculosis.: Clin Orthop Relat Res398:60-66
4. Dai, Jiang LY, Wang LS, Cui W, Y M (1976): Single-stage anterior autogenous bonegrafting and instrumentation in the surgical management of spinal tuberculosis.: Spine30(20):2342-2349
5. Ozdemir, Us HM, Ogun AK, T.(1976): The role of anterior spinal instrumentation andallograft fibula for the treatment of pott disease.: Spine28(5):474-479
6. Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posteriorinstrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal andlumbar spines. Spine (Phila Pa1976)20(17):1910-1916
7. Lee, Moon JS, Kim KP, Suh SJ, K T (2007): Posterior lumbar interbody fusion andposterior instrumentation in the surgical management of lumbar tuberculousspondylitis.: J Bone Joint Surg Br89(2):210-214
8. Chen, Chang YC, Wang MC, Yu ST, Liu WK, Chen CL, T H (2003): One-stageposterior surgery for treatment of advanced spinal tuberculosis.: J Chin Med Assoc66(7):411-417
9. Lee, Sung SH, Park JK, Y M (2006): Single-stage transpedicular decompression andposterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis:a retrospective case series.: J Spinal Disord Tech19(8):595-602
10. Guzey, Emel FK, Bas E, Hacisalihoglu NS, Seyithanoglu S, Karacor MH, Ozkan SE,Alatas N, Sel I, B.(2005): Thoracic and lumbar tuberculous spondylitis treated byposterior debridement, graft placement, and instrumentation: a retrospective analysis in19cases.: J Neurosurg Spine3(6):450-458
11. Tuli, S M (2007): Tuberculosis of the spine: a historical review.: Clin Orthop Relat Res460:29-38
12. Jain, Dhammi AK, I K (2007): Tuberculosis of the spine: a review.: Clin Orthop RelatRes460:39-49
13.王锡阳，魏伟强，李伟伟等(2009)一期后路病灶清除、植骨融合内固定术治疗胸腰椎结核.中国脊柱脊髓杂志19(11):813-817
14.姜传杰，杨永军，谭远超等(2010)一期后路病灶清除椎体钉内固定治疗中上胸椎结核.中国脊柱脊髓杂志20(4):326-330
15.盛伟斌，华强，曹力等(2005)一期后路病灶清除、楔形截骨矫形治疗胸腰椎结核并后凸或侧后凸畸形.中华外科杂志43(4):205-209
16.章文杰，洪正华，陈海啸等(2010)1期后路经椎弓根病灶清除及后路内固定治疗胸腰椎结核.浙江创伤外科15(3):289-290
17.李祥炎，徐皓，姚晓东等(2010)后路Ⅰ期病灶清除植骨内固定治疗胸椎、胸腰段脊柱结核.中国骨科临床与基础研究杂志2(1):21-24
18. Pu X, Zhou Q, He Q, Dai F, Xu J, Zhang Z, Branko K (2012) A posterior versus anteriorsurgical approach in combination with debridement, interbody autografting andinstrumentation for thoracic and lumbar tuberculosis. Int Orthop36(2):307-313.doi:10.1007/s00264-011-1329-0
19. O'Sullivan CE, Miller DR, Schneider PS, Roberts GD (2002) Evaluation of Gen-Probeamplified mycobacterium tuberculosis direct test by using respiratory andnonrespiratory specimens in a tertiary care center laboratory. J Clin Microbiol40(5):1723-1727
20. Honore-Bouakline S, Vincensini JP, Giacuzzo V, Lagrange PH, Herrmann JL (2003)Rapid diagnosis of extrapulmonary tuberculosis by PCR: impact of sample preparationand DNA extraction. J Clin Microbiol41(6):2323-2329
1. Belytschko T, Kulak RF, Schultz AB, Galante JO (1974) Finite element stress analysis ofan intervertebral disc. J Biomech7(3):277-285
2. Kotani Y, Cunningham BW, Parker LM, Kanayama M, McAfee PC (1999) Static andfatigue biomechanical properties of anterior thoracolumbar instrumentation systems. Asynthetic testing model. Spine (Phila Pa1976)24(14):1406-1413
3. Dick JC, Brodke DS, Zdeblick TA, Bartel BD, Kunz DN, Rapoff AJ (1997) Anteriorinstrumentation of the thoracolumbar spine. A biomechanical comparison. Spine (PhilaPa1976)22(7):744-750
4. Rohlmann A, Zander T, Bergmann G (2005) Comparison of the biomechanical effects ofposterior and anterior spine-stabilizing implants. Eur Spine J14(5):445-453.doi:10.1007/s00586-004-0784-3
5. Yu Y, Xie N, Song S, Zhang W, Guo Q, Ni B, Luo J (2011) A biomechanical comparisonof a novel thoracic screw fixation method: transarticular screw fixation vs traditionalpedicle screw fixation. Neurosurgery69(2Suppl Operative):ons141-145; discussionons146. doi:10.1227/NEU.0b013e31821867de
6. Pare PE, Chappuis JL, Rampersaud R, Agarwala AO, Perra JH, Erkan S, Wu C (2011)Biomechanical evaluation of a novel fenestrated pedicle screw augmented with bonecement in osteoporotic spines. Spine (Phila Pa1976)36(18):E1210-1214.doi:10.1097/BRS.0b013e318205e3af
7. Chen CS, Cheng CK, Liu CL (2002) A biomechanical comparison of posterolateralfusion and posterior fusion in the lumbar spine. J Spinal Disord Tech15(1):53-63
8. Goel VK, Kim YE, Lim TH, Weinstein JN (1988) An analytical investigation of themechanics of spinal instrumentation. Spine (Phila Pa1976)13(9):1003-1011
9. Guo LX, Wang ZW, Zhang YM, Lee KK, Teo EC, Li H, Wen BC (2009) Materialproperty sensitivity analysis on resonant frequency characteristics of the human spine. JAppl Biomech25(1):64-72
10. Wilcox RK, Boerger TO, Allen DJ, Barton DC, Limb D, Dickson RA, Hall RM (2003)A dynamic study of thoracolumbar burst fractures. J Bone Joint Surg Am85-A(11):2184-2189
11.闫家智，吴志宏，汪学松等(2009)腰椎三维有限元模型建立和应力分析.中华医学杂志89(17):1162-1165
12.闫家智，吴志宏，徐日成等(2009)腰椎后路单节段椎弓根螺钉内固定的三维有限元分析.中华医学杂志89(1):7-11
13.马辉，赵杰，连小峰等(2007)腰椎滑脱后路不同融合术式的有限元研究.中华骨科杂志27(4):282-286
14. Lim TH, Kim JG, Fujiwara A, Yoon TT, Lee SC, Ha JW, An HS (2001) Biomechanicalevaluation of diagonal fixation in pedicle screw instrumentation. Spine (Phila Pa1976)26(22):2498-2503
15. Rohlmann A, Calisse J, Bergmann G, Weber U (1999) Internal spinal fixator stiffnesshas only a minor influence on stresses in the adjacent discs. Spine (Phila Pa1976)24(12):1192-1195; discussion1195-1196
16. Chen CS, Chen WJ, Cheng CK, Jao SH, Chueh SC, Wang CC (2005) Failure analysis ofbroken pedicle screws on spinal instrumentation. Med Eng Phys27(6):487-496.doi:10.1016/j.medengphy.2004.12.007
17. Chen SI, Lin RM, Chang CH (2003) Biomechanical investigation of pediclescrew-vertebrae complex: a finite element approach using bonded and contact interfaceconditions. Med Eng Phys25(4):275-282
18. Zhang QH, Tan SH, Chou SM (2004) Investigation of fixation screw pull-out strengthon human spine. J Biomech37(4):479-485. doi:10.1016/j.jbiomech.2003.09.005
19. Qi W, Yan YB, Zhang Y, Lei W, Wang PJ, Hou J (2011) Study of stress distribution inpedicle screws along a continuum of diameters: a three-dimensional finite elementanalysis. Orthop Surg3(1):57-63. doi:10.1111/j.1757-7861.2010.00112.x
1. Annabel Baddeley HMD, Dennis Falzon (2011) Global tuberculosis controll2011WorldHealth Organization http://www.who.int/about/licensing/copyright_form/en/index.html
2. Tuli, S M (2007): Tuberculosis of the spine: a historical review.: Clin Orthop Relat Res460:29-38
3. A15-year assessment of controlled trials of the management of tuberculosis of the spinein Korea and Hong Kong. Thirteenth Report of the Medical Research Council WorkingParty on Tuberculosis of the Spine (1998). J Bone Joint Surg Br80(3):456-462
4. Jutte PC, Van Loenhout-Rooyackers JH (2006) Routine surgery in addition tochemotherapy for treating spinal tuberculosis. Cochrane Database Syst Rev(1):CD004532. doi:10.1002/14651858.CD004532.pub2
5. Nene A, Bhojraj S (2005) Results of nonsurgical treatment of thoracic spinal tuberculosisin adults. Spine J5(1):79-84. doi:10.1016/j.spinee.2004.05.255
6. Tuli SM (1975) Results of treatment of spinal tuberculosis by "middle-path" regime. JBone Joint Surg Br57(1):13-23
7. Kotil, Alan K, Bilge MS, T.(2007): Medical management of Pott disease in the thoracicand lumbar spine: a prospective clinical study.: J Neurosurg Spine6(3):222-228
8. Jain AK (2002) Treatment of tuberculosis of the spine with neurologic complications.Clin Orthop Relat Res (398):75-84
9.王自立，王骞(2010)脊柱结核的手术策略.中华骨科杂志30(7):717-722
10.许建中(2006)对脊柱结核手术指征和手术方式的再认识.中国脊柱脊髓杂志16(12):889-890
11. Tuli SM (1969) Treatment of neurological complications in tuberculosis of the spine. JBone Joint Surg Am51(4):680-692
12. Jain, A K (2007): Tuberculosis of the spine.: Clin Orthop Relat Res460:2-3
13. Jain, A K (2002): Treatment of tuberculosis of the spine with neurologic complications.:Clin Orthop Relat Res398:75-84
14. Yau AC, Hodgson AR (1968) Penetration of the lung by the paravertebral abscess intuberculosis of the spine. J Bone Joint Surg Am50(2):243-254
15.马远征，胡明，才晓军等。(2005)脊柱结核外科治疗的探讨.中华骨科杂志25(2):68-73
16.张西峰(2011)用微创的视角解读《脊柱结核的手术策略》.中华骨科杂志31(4):391-393
17.许建中(2011)脊柱结核的治疗存在仁智之争.中华骨科杂志394-399
18. Bakhsh A (2010) Medical management of spinal tuberculosis: an experience fromPakistan. Spine (Phila Pa1976)35(16):E787-791. doi:10.1097/BRS.0b013e3181d58c3c
19. Kumar K (1992) The penetration of drugs into the lesions of spinal tuberculosis. IntOrthop16(1):67-68
20. Tuli SM, Kumar K, Sen PC (1977) Penetration of antitubercular drugs in clinicalosteoarticular tubercular lesions. Acta Orthop Scand48(4):362-368
21. Ge Z, Wang Z, Wei M (2008) Measurement of the concentration of threeantituberculosis drugs in the focus of spinal tuberculosis. Eur Spine J17(11):1482-1487. doi:10.1007/s00586-008-0778-7
22. Dickinson JM (1969) The suitability of new drugs for intermittent chemotherapy oftuberculosis. An experimental study. Scand J Respir Dis Suppl69:91-98
23. Parthasarathy R, Sriram K, Santha T, Prabhakar R, Somasundaram PR,Sivasubramanian S (1999) Short-course chemotherapy for tuberculosis of the spine. Acomparison between ambulant treatment and radical surgery--ten-year report. J BoneJoint Surg Br81(3):464-471
24. Rajeswari R, Balasubramanian R, Venkatesan P, Sivasubramanian S, SoundarapandianS, Shanmugasundaram TK, Prabhakar R (1997) Short-course chemotherapy in thetreatment of Pott's paraplegia: report on five year follow-up. Int J Tuberc Lung Dis1(2):152-158
25. Ramachandran S, Clifton IJ, Collyns TA, Watson JP, Pearson SB (2005) The treatmentof spinal tuberculosis: a retrospective study. Int J Tuberc Lung Dis9(5):541-544
26. Oga, Arizono M, Takasita T, Sugioka M, Y.(1976): Evaluation of the risk ofinstrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study.:Spine18(13):1890-1894
27. Arens S, Schlegel U, Printzen G, Ziegler WJ, Perren SM, Hansis M (1996) Influence ofmaterials for fixation implants on local infection. An experimental study of steel versustitanium DCP in rabbits. J Bone Joint Surg Br78(4):647-651
28. Ha KY, Chung YG, Ryoo SJ (2005) Adherence and biofilm formation of Staphylococcusepidermidis and Mycobacterium tuberculosis on various spinal implants. Spine (PhilaPa1976)30(1):38-43
29. Benli, Acaroglu IT, Akalin E, Kis S, Duman M, Un E, A.(2003): Anterior radicaldebridement and anterior instrumentation in tuberculosis spondylitis.: Eur Spine J12(2):224-234
30.瞿东滨，金大地，陈建庭(2003)脊柱结核的一期手术治疗.中华医学杂志83(2):110-113
31.许建中，蒋电明，王爱明等(2008)脊柱结核再次手术原因分析及治疗方案选择.中华骨科杂志28(12):969-973
32.许建中，张泽华，周强等。(2006)一期前路病灶清除植骨融合内固定治疗腰骶椎结核.中国脊柱脊髓杂志16(12):897-900
33. Jain, Dhammi AK, Prashad IK, Sinha B, Mishra S, P.(2008): Simultaneous anteriordecompression and posterior instrumentation of the tuberculous spine using ananterolateral extrapleural approach.: J Bone Joint Surg Br90(11):1477-1481
34. Rajasekaran, Soundarapandian S, S.(1989): Progression of kyphosis in tuberculosis ofthe spine treated by anterior arthrodesis.: J Bone Joint Surg Am71(9):1314-1323
35. Pu X, Zhou Q, He Q, Dai F, Xu J, Zhang Z, Branko K (2012) A posterior versus anteriorsurgical approach in combination with debridement, interbody autografting andinstrumentation for thoracic and lumbar tuberculosis. Int Orthop36(2):307-313.doi:10.1007/s00264-011-1329-0
36. Jain AK, Jain S (2011) Instrumented stabilization in spinal tuberculosis. Int Orthop.doi:10.1007/s00264-011-1296-5
37. Jain AK (2010) Tuberculosis of the spine: a fresh look at an old disease. J Bone JointSurg Br92(7):905-913. doi:10.1302/0301-620x.92b7.24668
38. Jain, Maheshwari AK, Jena AV, S.(2007): Kyphus correction in spinal tuberculosis.:Clin Orthop Relat Res460:117-123
39. Lee, Sung SH, Park JK, Y M (2006): Single-stage transpedicular decompression andposterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis:a retrospective case series.: J Spinal Disord Tech19(8):595-602
40. Bezer, Kucukdurmaz M, Guven F, O.(2007): Transpedicular decancellation osteotomyin the treatment of posttuberculous kyphosis.: J Spinal Disord Tech20(3):209-215
41. Gokce, Ozturkmen A, Mutlu Y, Caniklioglu S, M.(2008): Spinal osteotomy: correctingsagittal balance in tuberculous spondylitis.: J Spinal Disord Tech21(7):484-488
42. Laheri, Badhe VJ, Dewnany NP, G T (2001): Single stage decompression, anteriorinterbody fusion and posterior instrumentation for tuberculous kyphosis of thedorso-lumbar spine.: Spinal Cord39(8):429-436
43. Moon, Woo MS, Lee YK, Ha KS, Kim KY, Sun SS, D H (1976): Posteriorinstrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal andlumbar spines.: Spine20(17):1910-1916
44. Louw, J A (1990): Spinal tuberculosis with neurological deficit. Treatment with anteriorvascularised rib grafts, posterior osteotomies and fusion.: J Bone Joint Surg Br72(4):686-693
45. Jin, Qu D, Chen D, Zhang J, H.(2004): One-stage anterior interbody autografting andinstrumentation in primary surgical management of thoracolumbar spinal tuberculosis.:Eur Spine J13(2):114-121
46. Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posteriorinstrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal andlumbar spines. Spine (Phila Pa1976)20(17):1910-1916
47.盛伟斌，华强，曹力等.(2005)一期后路病灶清除、楔形截骨矫形治疗胸腰椎结核并后凸或侧后凸畸形.中华外科杂志43(4):205-209
48.郭立新.陈兴马远征(2002)侧前方病灶清除椎弓根内固定治疗胸椎结核后凸畸形.中华骨科杂志22(11):662-665
49.顾晓峰，程力，周一逸.(2009)胸腰椎结核后路病灶清除一期植骨融合内固定术的疗效分析.中华医学杂志89(41):2898-2901
50. Yau, Hsu AC, Brien LCO, Hodgson JP, A R (1974): Tuberculous kyphosis: correctionwith spinal osteotomy, halo-pelvic distraction, and anterior and posterior fusion.: JBone Joint Surg Am56(7):1419-1434
51. Moon, Moon MS, Moon JL, Kim YW, Kim SS, Sun SS, Choi DH, W T (2003): Pott'sparaplegia in patients with severely deformed dorsal or dorsolumbar spines: treatmentand prognosis.: Spinal Cord41(3):164-171
52. Kalra, Dhar KP, Shetty SB, Dhariwal G, Q.(2006): Pedicle subtraction osteotomy forrigid post-tuberculous kyphosis.: J Bone Joint Surg Br88(7):925-927
53. Rajeswari, Ranjani R, Santha R, Sriram T, Prabhakar K, R.(1997): Late onsetparaplegia--a sequela to Pott's disease. A report on imaging, prevention andmanagement.: Int J Tuberc Lung Dis1(5):468-473
54. Bilsel, Aydingoz N, Hanci O, Erdogan M, F.(2000): Late onset Pott's paraplegia.:Spinal Cord38(11):669-674
55. Wong YW, Leong JC, Luk KD (2007) Direct internal kyphectomy for severe angulartuberculous kyphosis. Clin Orthop Relat Res460:124-129. doi:10.1097/BLO.0b013e31805470db
56. Pande KC, Babhulkar SS (2002) Atypical spinal tuberculosis. Clin Orthop Relat Res(398):67-74
57. Naim-ur-Rahman (1980): Atypical forms of spinal tuberculosis.: J Bone Joint SurgBr:162-165
58.刘兴炎，葛宝丰，甄平等(2001)非典型脊柱结核的诊断与治疗.中国脊柱脊髓杂志11(2):116-117
59. Kumar, Jain S, Dhammi AK, Aggarwal IK, A N (2007): Treatment of intraspinaltuberculoma.: Clin Orthop Relat Res460:62-66
60. Jena, Banerji A, Tripathi AK, Gulati RP, Jain PK, Khushu RK, Sapra S, M L (1991):Demonstration of intramedullary tuberculomas by magnetic resonance imaging: areport of two cases.: Br J Radiol64(762):555-557
61.施建党，王自立。(2010)非典型脊柱结核的早期诊断.中国脊柱脊髓杂志20(5):432-434
62. Loddenkemper R, Sagebiel D, Brendel A (2002) Strategies against multidrug-resistanttuberculosis. Eur Respir J Suppl36:66s-77s
63. Watters DA (1997) Surgery for tuberculosis before and after human immunodeficiencyvirus infection: a tropical perspective. Br J Surg84(1):8-14
64.吴铮，张泽华，许建中。(2010)脊柱结核个体化药物治疗的临床效果观察.中华外科杂志48(15)
65.张泽华，万东勇，许建中等.(2008)结核分枝杆菌快速培养和常规药敏试验在脊柱结核治疗中的应用.中华骨科杂志28(12):988-991
66. Victor TC, Lee H, Cho SN, Jordaan AM, van der Spuy G, van Helden PD, Warren R(2002) Molecular detection of early appearance of drug resistance duringMycobacterium tuberculosis infection. Clin Chem Lab Med40(9):876-881.doi:10.1515/cclm.2002.155
67. Garcia de Viedma D, del Sol Diaz Infantes M, Lasala F, Chaves F, Alcala L, Bouza E(2002) New real-time PCR able to detect in a single tube multiple rifampin resistancemutations and high-level isoniazid resistance mutations in Mycobacterium tuberculosis.J Clin Microbiol40(3):988-995
68. Palomino JC (2009) Molecular detection, identification and drug resistance detection inMycobacterium tuberculosis. FEMS Immunol Med Microbiol56(2):103-111.doi:10.1111/j.1574-695X.2009.00555.x
2.方先之(1957)骨关节结核病灶清除疗法北京人民卫生出版社
3. Guven, Kumano O, Yalcin K, Karahan S, Tsuji M, S.(1976): A single stage posteriorapproach and rigid fixation for preventing kyphosis in the treatment of spinaltuberculosis.: Spine19(9):1039-1043
4. Fukuta, Miyamoto S, Masuda K, Hosoe T, Kodama H, Nishimoto H, Sakaeda H,Shimizu H, K.(1976): Two-stage (posterior and anterior) surgical treatment usingposterior spinal instrumentation for pyogenic and tuberculotic spondylitis.: Spine28(15):E302-308
5. Jain, Dhammi AK, Prashad IK, Sinha B, Mishra S, P.(2008): Simultaneous anteriordecompression and posterior instrumentation of the tuberculous spine using ananterolateral extrapleural approach.: J Bone Joint Surg Br90(11):1477-1481
6. Lee SH, Sung JK, Park YM (2006) Single-stage transpedicular decompression andposterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis:a retrospective case series. J Spinal Disord Tech19(8):595-602. doi:10.1097/01.bsd.0000211241.06588.7b00024720-200612000-00010[pii]
7. Tuli, S M (2007): Tuberculosis of the spine: a historical review.: Clin Orthop Relat Res460:29-38
8. Jain, A K (2007): Tuberculosis of the spine.: Clin Orthop Relat Res460:2-3
9.许建中(2006)对脊柱结核手术指征和手术方式的再认识.中国脊柱脊髓杂志16(12):889-890
10. Hodgson, A-R S, F-E F, H-S ONG, G B (1960): Anterior spinal fusion. The operativeapproach and pathological findings in412patients with Pott's disease of the spine.: BrJ Surg48:172-178
11. Stock, F E (1969): Anterior spinal fusion.1. A radical approach to the treatment oftuberculous disease of the spine.: Nurs Times65(17):532-534
12. Lougheed, J-C W, W G (1960): Anterior dependent drainage for tuberculouslumbosacral spinal lesions. Coccygectomy and dependent drainage in treatment oftuberculous lesions of the lower spine with associated soft-tissue abscesses.: Arch Surg81:961-964
13. Mitchell, R M (1966): Anterior spinal fusion in spinal tuberculosis using an iliac boneblock.: East Afr Med J43(4):119-122
14. Cameron, J-A R, C-L R, D E (1962): The radical treatment of Pott's disease and Pott'sparaplegia by extirpation of the diseased area and anterior spinal fusion.: Am RevRespir Dis86:76-80
15. Oishi, S O, Y I, A K, T Y, T I, O K, M.(1964):[Radical Surgery of Spinal Tuberculosiswith Anterior Spinal Fusion.].: Nippon Seikeigeka Gakkai Zasshi38:564-565
16. Khan, M A (1964): The place of anterior spinal fusion in treatment of tuberculosis ofthe spine.: Clin Orthop Relat Res35:139-149
17. Tangco, Rivera AF, Silao MT, Awitan JVJ, A P, Jr.(1966): Approaches in anterior spinalfusion.: Philipp J Surg Surg Spec21(3):155-159
18. Stock, F E (1969): Anterior spinal fusion.2. A radical approach to the treatment oftuberculous disease of the spine.: Nurs Times65(18):564-566
19. Kim, Yun DJ, Moon YH, Riew SH, K D (1976): Posterior instrumentation usingcompressive laminar hooks and anterior interbody arthrodesis for the treatment oftuberculosis of the lower lumbar spine.: Spine29(13):E275-279
20. Benli, Kis IT, Akalin M, Citak S, Kanevetci M, Duman S, E.(2000): The results ofanterior radical debridement and anterior instrumentation in Pott's disease andcomparison with other surgical techniques.: Kobe J Med Sci46(1-2):39-68
21. Oga, Arizono M, Takasita T, Sugioka M, Y.(1976): Evaluation of the risk ofinstrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study.:Spine18(13):1890-1894
22. Ha KY, Chung YG, Ryoo SJ (2005) Adherence and biofilm formation of Staphylococcusepidermidis and Mycobacterium tuberculosis on various spinal implants. Spine (PhilaPa1976)30(1):38-43
23.Hirakawa, Miyamoto A, Masuda K, Fukuta T, Hosoe S, Iinuma H, Iwai N, Nishimoto C,Shimizu H, K.: Surgical outcome of2-stage (posterior and anterior) surgical treatmentusing spinal instrumentation for tuberculous spondylitis.: J Spinal Disord Tech23(2):133-138
24. Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posteriorinstrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal andlumbar spines. Spine (Phila Pa1976)20(17):1910-1916
25. Klockner, Valencia C, R.(1976): Sagittal alignment after anterior debridement andfusion with or without additional posterior instrumentation in the treatment of pyogenicand tuberculous spondylodiscitis.: Spine28(10):1036-1042
26. MS M, YK W, KS L, KY H, SS K, DH S (1976)-Posterior instrumentation and anteriorinterbody fusion for tuberculous kyphosis. Spine20(17):1910-1916
27. Guven O (1996) Posterior instrumentation and anterior interbody fusion for tuberculouskyphosis of dorsal and lumbar spines. Spine (Phila Pa1976)21(15):1840-1841
28. Laheri, Badhe VJ, Dewnany NP, G T (2001): Single stage decompression, anteriorinterbody fusion and posterior instrumentation for tuberculous kyphosis of thedorso-lumbar spine.: Spinal Cord39(8):429-436
29. Mukhtar, Farghaly AM, Ahmed MM, S H (2003): Surgical treatment of thoracic andlumbar tuberculosis by anterior interbody fusion and posterior instrumentation.: MedPrinc Pract12(2):92-96
30. Talu, Gogus U, Ozturk A, Hamzaoglu C, Domanic A, U.(2006): The role of posteriorinstrumentation and fusion after anterior radical debridement and fusion in the surgicaltreatment of spinal tuberculosis: experience of127cases.: J Spinal Disord Tech19(8):554-559
31. Gu, Cheng XF, Zhou L, Y Y (2009):[Radical debridement and single stage posteriorspinal fusion and instrumentation for the treatment of thoracic-lumber tuberculosis].:Zhonghua Yi Xue Za Zhi89(41):2898-2901
32. Xu, Yang YG, Liu YD, S L (2009):[Effect of surgical treatment for thoracolumbarspinal tuberculosis by anterior radical debridement with bone graft fusion and posteriorpedicle screw-rods system fixation].: Zhongguo Gu Shang22(12):938-940
33. Sundararaj, G D (2009): Simultaneous anterior decompression and posteriorinstrumentation of the tuberculous spine using an anterolateral extrapleural approach.:J Bone Joint Surg Br91(5):702-703
34. Oga M, Arizono T, Takasita M, Sugioka Y (1993) Evaluation of the risk ofinstrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study.Spine (Phila Pa1976)18(13):1890-1894
35. Yilmaz, Selek C, Gurkan HY, Erdemli I, Korkusuz B, Z.(1999): Anteriorinstrumentation for the treatment of spinal tuberculosis.: J Bone Joint Surg Am81(9):1261-1267
36. Benli, Kaya IT, Acaroglu A, E.(2007): Anterior instrumentation in tuberculousspondylitis: is it effective and safe?: Clin Orthop Relat Res460:108-116
37. Obaid-ur-Rahman A, Hussain S, T.(2009): Anterior surgical interventions in spinaltuberculosis.: J Coll Physicians Surg Pak19(8):500-505
38. Jin, Chen D, Zhang J, Zhai H, Wang D, Jiang J, J.(2000):[Anterior interbodyautografting and internal fixation for primary surgical management of thoracolumbarspinal tuberculosis].: Zhonghua Wai Ke Za Zhi38(12):900-902
39. Jin, Qu D, Chen D, Zhang J, H.(2004): One-stage anterior interbody autografting andinstrumentation in primary surgical management of thoracolumbar spinal tuberculosis.:Eur Spine J13(2):114-121
40. Christodoulou, Givissis AG, Karataglis P, Symeonidis D, Pournaras PD, J.(2006):Treatment of tuberculous spondylitis with anterior stabilization and titanium cage.:Clin Orthop Relat Res444:60-65
41.郭立新，马远征，陈兴等.(2008)脊柱结核的外科治疗与术后疗效评估.中华骨科杂志28(12):979-982
42.丁江平，翁习生，王斌等(2007)经脊柱前路病灶清除植骨一期前路内固定术治疗脊柱结核.中华骨科杂志27(1):54-58
43.许建中，张泽华，周强等(2006)一期前路病灶清除植骨融合内固定治疗腰骶椎结核.中国脊柱脊髓杂志16(12):897-900
44. Garst, R J (1992): Tuberculosis of the spine: a review of236operated cases in anunderdeveloped region from1954to1964.: J Spinal Disord5(3):286-300
45. Guven O, Kumano K, Yalcin S, Karahan M, Tsuji S (1994) A single stage posteriorapproach and rigid fixation for preventing kyphosis in the treatment of spinaltuberculosis. Spine (Phila Pa1976)19(9):1039-1043
46.姜传杰，杨永军，谭远超等(2010)一期后路病灶清除椎体钉内固定治疗中上胸椎结核.中国脊柱脊髓杂志20(4):326-330
47.李祥炎，徐皓，姚晓东等(2010)后路Ⅰ期病灶清除植骨内固定治疗胸椎、胸腰段脊柱结核.中国骨科临床与基础研究杂志2(1):21-24
48.盛伟斌，华强，曹力等(2005)一期后路病灶清除、楔形截骨矫形治疗胸腰椎结核并后凸或侧后凸畸形.中华外科杂志43(4):205-209
49.王锡阳，魏伟强，李伟伟等(2009)一期后路病灶清除、植骨融合内固定术治疗胸腰椎结核.中国脊柱脊髓杂志19(11):813-817
50.章文杰，洪正华，陈海啸等(2010)1期后路经椎弓根病灶清除及后路内固定治疗胸腰椎结核.浙江创伤外科15(3):289-290
51. Pu X, Zhou Q, He Q, Dai F, Xu J, Zhang Z, Branko K (2012) A posterior versus anteriorsurgical approach in combination with debridement, interbody autografting andinstrumentation for thoracic and lumbar tuberculosis. Int Orthop36(2):307-313.doi:10.1007/s00264-011-1329-0
1. Hodgson, A-R S, F-E F, H-S ONG, G B (1960): Anterior spinal fusion. The operativeapproach and pathological findings in412patients with Pott's disease of the spine.: BrJ Surg48:172-178
2. Benli, Kaya IT, Acaroglu A, E.(2007): Anterior instrumentation in tuberculousspondylitis: is it effective and safe?: Clin Orthop Relat Res460:108-116
3. Govender, S.(2002): The outcome of allografts and anterior instrumentation in spinaltuberculosis.: Clin Orthop Relat Res398:60-66
4. Dai, Jiang LY, Wang LS, Cui W, Y M (1976): Single-stage anterior autogenous bonegrafting and instrumentation in the surgical management of spinal tuberculosis.: Spine30(20):2342-2349
5. Ozdemir, Us HM, Ogun AK, T.(1976): The role of anterior spinal instrumentation andallograft fibula for the treatment of pott disease.: Spine28(5):474-479
6. Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posteriorinstrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal andlumbar spines. Spine (Phila Pa1976)20(17):1910-1916
7. Lee, Moon JS, Kim KP, Suh SJ, K T (2007): Posterior lumbar interbody fusion andposterior instrumentation in the surgical management of lumbar tuberculousspondylitis.: J Bone Joint Surg Br89(2):210-214
8. Chen, Chang YC, Wang MC, Yu ST, Liu WK, Chen CL, T H (2003): One-stageposterior surgery for treatment of advanced spinal tuberculosis.: J Chin Med Assoc66(7):411-417
9. Lee, Sung SH, Park JK, Y M (2006): Single-stage transpedicular decompression andposterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis:a retrospective case series.: J Spinal Disord Tech19(8):595-602
10. Guzey, Emel FK, Bas E, Hacisalihoglu NS, Seyithanoglu S, Karacor MH, Ozkan SE,Alatas N, Sel I, B.(2005): Thoracic and lumbar tuberculous spondylitis treated byposterior debridement, graft placement, and instrumentation: a retrospective analysis in19cases.: J Neurosurg Spine3(6):450-458
11. Tuli, S M (2007): Tuberculosis of the spine: a historical review.: Clin Orthop Relat Res460:29-38
12. Jain, Dhammi AK, I K (2007): Tuberculosis of the spine: a review.: Clin Orthop RelatRes460:39-49
13.王锡阳，魏伟强，李伟伟等(2009)一期后路病灶清除、植骨融合内固定术治疗胸腰椎结核.中国脊柱脊髓杂志19(11):813-817
14.姜传杰，杨永军，谭远超等(2010)一期后路病灶清除椎体钉内固定治疗中上胸椎结核.中国脊柱脊髓杂志20(4):326-330
15.盛伟斌，华强，曹力等(2005)一期后路病灶清除、楔形截骨矫形治疗胸腰椎结核并后凸或侧后凸畸形.中华外科杂志43(4):205-209
16.章文杰，洪正华，陈海啸等(2010)1期后路经椎弓根病灶清除及后路内固定治疗胸腰椎结核.浙江创伤外科15(3):289-290
17.李祥炎，徐皓，姚晓东等(2010)后路Ⅰ期病灶清除植骨内固定治疗胸椎、胸腰段脊柱结核.中国骨科临床与基础研究杂志2(1):21-24
18. Pu X, Zhou Q, He Q, Dai F, Xu J, Zhang Z, Branko K (2012) A posterior versus anteriorsurgical approach in combination with debridement, interbody autografting andinstrumentation for thoracic and lumbar tuberculosis. Int Orthop36(2):307-313.doi:10.1007/s00264-011-1329-0
19. O'Sullivan CE, Miller DR, Schneider PS, Roberts GD (2002) Evaluation of Gen-Probeamplified mycobacterium tuberculosis direct test by using respiratory andnonrespiratory specimens in a tertiary care center laboratory. J Clin Microbiol40(5):1723-1727
20. Honore-Bouakline S, Vincensini JP, Giacuzzo V, Lagrange PH, Herrmann JL (2003)Rapid diagnosis of extrapulmonary tuberculosis by PCR: impact of sample preparationand DNA extraction. J Clin Microbiol41(6):2323-2329
1. Belytschko T, Kulak RF, Schultz AB, Galante JO (1974) Finite element stress analysis ofan intervertebral disc. J Biomech7(3):277-285
2. Kotani Y, Cunningham BW, Parker LM, Kanayama M, McAfee PC (1999) Static andfatigue biomechanical properties of anterior thoracolumbar instrumentation systems. Asynthetic testing model. Spine (Phila Pa1976)24(14):1406-1413
3. Dick JC, Brodke DS, Zdeblick TA, Bartel BD, Kunz DN, Rapoff AJ (1997) Anteriorinstrumentation of the thoracolumbar spine. A biomechanical comparison. Spine (PhilaPa1976)22(7):744-750
4. Rohlmann A, Zander T, Bergmann G (2005) Comparison of the biomechanical effects ofposterior and anterior spine-stabilizing implants. Eur Spine J14(5):445-453.doi:10.1007/s00586-004-0784-3
5. Yu Y, Xie N, Song S, Zhang W, Guo Q, Ni B, Luo J (2011) A biomechanical comparisonof a novel thoracic screw fixation method: transarticular screw fixation vs traditionalpedicle screw fixation. Neurosurgery69(2Suppl Operative):ons141-145; discussionons146. doi:10.1227/NEU.0b013e31821867de
6. Pare PE, Chappuis JL, Rampersaud R, Agarwala AO, Perra JH, Erkan S, Wu C (2011)Biomechanical evaluation of a novel fenestrated pedicle screw augmented with bonecement in osteoporotic spines. Spine (Phila Pa1976)36(18):E1210-1214.doi:10.1097/BRS.0b013e318205e3af
7. Chen CS, Cheng CK, Liu CL (2002) A biomechanical comparison of posterolateralfusion and posterior fusion in the lumbar spine. J Spinal Disord Tech15(1):53-63
8. Goel VK, Kim YE, Lim TH, Weinstein JN (1988) An analytical investigation of themechanics of spinal instrumentation. Spine (Phila Pa1976)13(9):1003-1011
9. Guo LX, Wang ZW, Zhang YM, Lee KK, Teo EC, Li H, Wen BC (2009) Materialproperty sensitivity analysis on resonant frequency characteristics of the human spine. JAppl Biomech25(1):64-72
10. Wilcox RK, Boerger TO, Allen DJ, Barton DC, Limb D, Dickson RA, Hall RM (2003)A dynamic study of thoracolumbar burst fractures. J Bone Joint Surg Am85-A(11):2184-2189
11.闫家智，吴志宏，汪学松等(2009)腰椎三维有限元模型建立和应力分析.中华医学杂志89(17):1162-1165
12.闫家智，吴志宏，徐日成等(2009)腰椎后路单节段椎弓根螺钉内固定的三维有限元分析.中华医学杂志89(1):7-11
13.马辉，赵杰，连小峰等(2007)腰椎滑脱后路不同融合术式的有限元研究.中华骨科杂志27(4):282-286
14. Lim TH, Kim JG, Fujiwara A, Yoon TT, Lee SC, Ha JW, An HS (2001) Biomechanicalevaluation of diagonal fixation in pedicle screw instrumentation. Spine (Phila Pa1976)26(22):2498-2503
15. Rohlmann A, Calisse J, Bergmann G, Weber U (1999) Internal spinal fixator stiffnesshas only a minor influence on stresses in the adjacent discs. Spine (Phila Pa1976)24(12):1192-1195; discussion1195-1196
16. Chen CS, Chen WJ, Cheng CK, Jao SH, Chueh SC, Wang CC (2005) Failure analysis ofbroken pedicle screws on spinal instrumentation. Med Eng Phys27(6):487-496.doi:10.1016/j.medengphy.2004.12.007
17. Chen SI, Lin RM, Chang CH (2003) Biomechanical investigation of pediclescrew-vertebrae complex: a finite element approach using bonded and contact interfaceconditions. Med Eng Phys25(4):275-282
18. Zhang QH, Tan SH, Chou SM (2004) Investigation of fixation screw pull-out strengthon human spine. J Biomech37(4):479-485. doi:10.1016/j.jbiomech.2003.09.005
19. Qi W, Yan YB, Zhang Y, Lei W, Wang PJ, Hou J (2011) Study of stress distribution inpedicle screws along a continuum of diameters: a three-dimensional finite elementanalysis. Orthop Surg3(1):57-63. doi:10.1111/j.1757-7861.2010.00112.x
1. Annabel Baddeley HMD, Dennis Falzon (2011) Global tuberculosis controll2011WorldHealth Organization http://www.who.int/about/licensing/copyright_form/en/index.html
2. Tuli, S M (2007): Tuberculosis of the spine: a historical review.: Clin Orthop Relat Res460:29-38
3. A15-year assessment of controlled trials of the management of tuberculosis of the spinein Korea and Hong Kong. Thirteenth Report of the Medical Research Council WorkingParty on Tuberculosis of the Spine (1998). J Bone Joint Surg Br80(3):456-462
4. Jutte PC, Van Loenhout-Rooyackers JH (2006) Routine surgery in addition tochemotherapy for treating spinal tuberculosis. Cochrane Database Syst Rev(1):CD004532. doi:10.1002/14651858.CD004532.pub2
5. Nene A, Bhojraj S (2005) Results of nonsurgical treatment of thoracic spinal tuberculosisin adults. Spine J5(1):79-84. doi:10.1016/j.spinee.2004.05.255
6. Tuli SM (1975) Results of treatment of spinal tuberculosis by "middle-path" regime. JBone Joint Surg Br57(1):13-23
7. Kotil, Alan K, Bilge MS, T.(2007): Medical management of Pott disease in the thoracicand lumbar spine: a prospective clinical study.: J Neurosurg Spine6(3):222-228
8. Jain AK (2002) Treatment of tuberculosis of the spine with neurologic complications.Clin Orthop Relat Res (398):75-84
9.王自立，王骞(2010)脊柱结核的手术策略.中华骨科杂志30(7):717-722
10.许建中(2006)对脊柱结核手术指征和手术方式的再认识.中国脊柱脊髓杂志16(12):889-890
11. Tuli SM (1969) Treatment of neurological complications in tuberculosis of the spine. JBone Joint Surg Am51(4):680-692
12. Jain, A K (2007): Tuberculosis of the spine.: Clin Orthop Relat Res460:2-3
13. Jain, A K (2002): Treatment of tuberculosis of the spine with neurologic complications.:Clin Orthop Relat Res398:75-84
14. Yau AC, Hodgson AR (1968) Penetration of the lung by the paravertebral abscess intuberculosis of the spine. J Bone Joint Surg Am50(2):243-254
15.马远征，胡明，才晓军等。(2005)脊柱结核外科治疗的探讨.中华骨科杂志25(2):68-73
16.张西峰(2011)用微创的视角解读《脊柱结核的手术策略》.中华骨科杂志31(4):391-393
17.许建中(2011)脊柱结核的治疗存在仁智之争.中华骨科杂志394-399
18. Bakhsh A (2010) Medical management of spinal tuberculosis: an experience fromPakistan. Spine (Phila Pa1976)35(16):E787-791. doi:10.1097/BRS.0b013e3181d58c3c
19. Kumar K (1992) The penetration of drugs into the lesions of spinal tuberculosis. IntOrthop16(1):67-68
20. Tuli SM, Kumar K, Sen PC (1977) Penetration of antitubercular drugs in clinicalosteoarticular tubercular lesions. Acta Orthop Scand48(4):362-368
21. Ge Z, Wang Z, Wei M (2008) Measurement of the concentration of threeantituberculosis drugs in the focus of spinal tuberculosis. Eur Spine J17(11):1482-1487. doi:10.1007/s00586-008-0778-7
22. Dickinson JM (1969) The suitability of new drugs for intermittent chemotherapy oftuberculosis. An experimental study. Scand J Respir Dis Suppl69:91-98
23. Parthasarathy R, Sriram K, Santha T, Prabhakar R, Somasundaram PR,Sivasubramanian S (1999) Short-course chemotherapy for tuberculosis of the spine. Acomparison between ambulant treatment and radical surgery--ten-year report. J BoneJoint Surg Br81(3):464-471
24. Rajeswari R, Balasubramanian R, Venkatesan P, Sivasubramanian S, SoundarapandianS, Shanmugasundaram TK, Prabhakar R (1997) Short-course chemotherapy in thetreatment of Pott's paraplegia: report on five year follow-up. Int J Tuberc Lung Dis1(2):152-158
25. Ramachandran S, Clifton IJ, Collyns TA, Watson JP, Pearson SB (2005) The treatmentof spinal tuberculosis: a retrospective study. Int J Tuberc Lung Dis9(5):541-544
26. Oga, Arizono M, Takasita T, Sugioka M, Y.(1976): Evaluation of the risk ofinstrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study.:Spine18(13):1890-1894
27. Arens S, Schlegel U, Printzen G, Ziegler WJ, Perren SM, Hansis M (1996) Influence ofmaterials for fixation implants on local infection. An experimental study of steel versustitanium DCP in rabbits. J Bone Joint Surg Br78(4):647-651
28. Ha KY, Chung YG, Ryoo SJ (2005) Adherence and biofilm formation of Staphylococcusepidermidis and Mycobacterium tuberculosis on various spinal implants. Spine (PhilaPa1976)30(1):38-43
29. Benli, Acaroglu IT, Akalin E, Kis S, Duman M, Un E, A.(2003): Anterior radicaldebridement and anterior instrumentation in tuberculosis spondylitis.: Eur Spine J12(2):224-234
30.瞿东滨，金大地，陈建庭(2003)脊柱结核的一期手术治疗.中华医学杂志83(2):110-113
31.许建中，蒋电明，王爱明等(2008)脊柱结核再次手术原因分析及治疗方案选择.中华骨科杂志28(12):969-973
32.许建中，张泽华，周强等。(2006)一期前路病灶清除植骨融合内固定治疗腰骶椎结核.中国脊柱脊髓杂志16(12):897-900
33. Jain, Dhammi AK, Prashad IK, Sinha B, Mishra S, P.(2008): Simultaneous anteriordecompression and posterior instrumentation of the tuberculous spine using ananterolateral extrapleural approach.: J Bone Joint Surg Br90(11):1477-1481
34. Rajasekaran, Soundarapandian S, S.(1989): Progression of kyphosis in tuberculosis ofthe spine treated by anterior arthrodesis.: J Bone Joint Surg Am71(9):1314-1323
35. Pu X, Zhou Q, He Q, Dai F, Xu J, Zhang Z, Branko K (2012) A posterior versus anteriorsurgical approach in combination with debridement, interbody autografting andinstrumentation for thoracic and lumbar tuberculosis. Int Orthop36(2):307-313.doi:10.1007/s00264-011-1329-0
36. Jain AK, Jain S (2011) Instrumented stabilization in spinal tuberculosis. Int Orthop.doi:10.1007/s00264-011-1296-5
37. Jain AK (2010) Tuberculosis of the spine: a fresh look at an old disease. J Bone JointSurg Br92(7):905-913. doi:10.1302/0301-620x.92b7.24668
38. Jain, Maheshwari AK, Jena AV, S.(2007): Kyphus correction in spinal tuberculosis.:Clin Orthop Relat Res460:117-123
39. Lee, Sung SH, Park JK, Y M (2006): Single-stage transpedicular decompression andposterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis:a retrospective case series.: J Spinal Disord Tech19(8):595-602
40. Bezer, Kucukdurmaz M, Guven F, O.(2007): Transpedicular decancellation osteotomyin the treatment of posttuberculous kyphosis.: J Spinal Disord Tech20(3):209-215
41. Gokce, Ozturkmen A, Mutlu Y, Caniklioglu S, M.(2008): Spinal osteotomy: correctingsagittal balance in tuberculous spondylitis.: J Spinal Disord Tech21(7):484-488
42. Laheri, Badhe VJ, Dewnany NP, G T (2001): Single stage decompression, anteriorinterbody fusion and posterior instrumentation for tuberculous kyphosis of thedorso-lumbar spine.: Spinal Cord39(8):429-436
43. Moon, Woo MS, Lee YK, Ha KS, Kim KY, Sun SS, D H (1976): Posteriorinstrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal andlumbar spines.: Spine20(17):1910-1916
44. Louw, J A (1990): Spinal tuberculosis with neurological deficit. Treatment with anteriorvascularised rib grafts, posterior osteotomies and fusion.: J Bone Joint Surg Br72(4):686-693
45. Jin, Qu D, Chen D, Zhang J, H.(2004): One-stage anterior interbody autografting andinstrumentation in primary surgical management of thoracolumbar spinal tuberculosis.:Eur Spine J13(2):114-121
46. Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posteriorinstrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal andlumbar spines. Spine (Phila Pa1976)20(17):1910-1916
47.盛伟斌，华强，曹力等.(2005)一期后路病灶清除、楔形截骨矫形治疗胸腰椎结核并后凸或侧后凸畸形.中华外科杂志43(4):205-209
48.郭立新.陈兴马远征(2002)侧前方病灶清除椎弓根内固定治疗胸椎结核后凸畸形.中华骨科杂志22(11):662-665
49.顾晓峰，程力，周一逸.(2009)胸腰椎结核后路病灶清除一期植骨融合内固定术的疗效分析.中华医学杂志89(41):2898-2901
50. Yau, Hsu AC, Brien LCO, Hodgson JP, A R (1974): Tuberculous kyphosis: correctionwith spinal osteotomy, halo-pelvic distraction, and anterior and posterior fusion.: JBone Joint Surg Am56(7):1419-1434
51. Moon, Moon MS, Moon JL, Kim YW, Kim SS, Sun SS, Choi DH, W T (2003): Pott'sparaplegia in patients with severely deformed dorsal or dorsolumbar spines: treatmentand prognosis.: Spinal Cord41(3):164-171
52. Kalra, Dhar KP, Shetty SB, Dhariwal G, Q.(2006): Pedicle subtraction osteotomy forrigid post-tuberculous kyphosis.: J Bone Joint Surg Br88(7):925-927
53. Rajeswari, Ranjani R, Santha R, Sriram T, Prabhakar K, R.(1997): Late onsetparaplegia--a sequela to Pott's disease. A report on imaging, prevention andmanagement.: Int J Tuberc Lung Dis1(5):468-473
54. Bilsel, Aydingoz N, Hanci O, Erdogan M, F.(2000): Late onset Pott's paraplegia.:Spinal Cord38(11):669-674
55. Wong YW, Leong JC, Luk KD (2007) Direct internal kyphectomy for severe angulartuberculous kyphosis. Clin Orthop Relat Res460:124-129. doi:10.1097/BLO.0b013e31805470db
56. Pande KC, Babhulkar SS (2002) Atypical spinal tuberculosis. Clin Orthop Relat Res(398):67-74
57. Naim-ur-Rahman (1980): Atypical forms of spinal tuberculosis.: J Bone Joint SurgBr:162-165
58.刘兴炎，葛宝丰，甄平等(2001)非典型脊柱结核的诊断与治疗.中国脊柱脊髓杂志11(2):116-117
59. Kumar, Jain S, Dhammi AK, Aggarwal IK, A N (2007): Treatment of intraspinaltuberculoma.: Clin Orthop Relat Res460:62-66
60. Jena, Banerji A, Tripathi AK, Gulati RP, Jain PK, Khushu RK, Sapra S, M L (1991):Demonstration of intramedullary tuberculomas by magnetic resonance imaging: areport of two cases.: Br J Radiol64(762):555-557
61.施建党，王自立。(2010)非典型脊柱结核的早期诊断.中国脊柱脊髓杂志20(5):432-434
62. Loddenkemper R, Sagebiel D, Brendel A (2002) Strategies against multidrug-resistanttuberculosis. Eur Respir J Suppl36:66s-77s
63. Watters DA (1997) Surgery for tuberculosis before and after human immunodeficiencyvirus infection: a tropical perspective. Br J Surg84(1):8-14
64.吴铮，张泽华，许建中。(2010)脊柱结核个体化药物治疗的临床效果观察.中华外科杂志48(15)
65.张泽华，万东勇，许建中等.(2008)结核分枝杆菌快速培养和常规药敏试验在脊柱结核治疗中的应用.中华骨科杂志28(12):988-991
66. Victor TC, Lee H, Cho SN, Jordaan AM, van der Spuy G, van Helden PD, Warren R(2002) Molecular detection of early appearance of drug resistance duringMycobacterium tuberculosis infection. Clin Chem Lab Med40(9):876-881.doi:10.1515/cclm.2002.155
67. Garcia de Viedma D, del Sol Diaz Infantes M, Lasala F, Chaves F, Alcala L, Bouza E(2002) New real-time PCR able to detect in a single tube multiple rifampin resistancemutations and high-level isoniazid resistance mutations in Mycobacterium tuberculosis.J Clin Microbiol40(3):988-995
68. Palomino JC (2009) Molecular detection, identification and drug resistance detection inMycobacterium tuberculosis. FEMS Immunol Med Microbiol56(2):103-111.doi:10.1111/j.1574-695X.2009.00555.x