The present Aspect of Bone and Joint Tuberculosis Especially in Tuberculosis of the Spine
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In recent years the number of patients with spinal tuberculosis has been decreased, this is caused by improved preventive measures, widespread use of antituberculous chemotherapy and better surgical treatmentProgress in spinal surgery has been great and the surgical approach to every part of spine has been studied. The most widely accepted surgical regimen which has gained acceptance consists of curettage of the foci of infection in the vertebrae using an anterior approach followed by autogenous bone graft into the curetted area. The author has been using this particular regimem since 1955.During the past five years, the author has operated on 288 cases of spinal tuberculosis cervical vertebrae, 3 cases; thoracic vertebrae, 57 cases; thoracolumbar vertebrae, 78 cases; lumbar vertebrae, 73 cases; and lumbosacral vertebtae, 77 cases.The author approaches the region extending from the third cervical to the second thoracic vertebra by an incision along the anterior border of the sternocleidomastoid muscle.In the thoracic vertebrae, the author prefers an extrapleural approach, since these cases experience less interference with respiratory function than does a transpleural dissection.In the thoracolumbar region, the author uses the same extrapleural approach, the costai and lumbar fibers of the diaphragm are spread using blunt dissection. The retroperitoneal space is easily entered by reflecting the peritoneum with the fingers.In the lower lumbar and lumbosacral region, a midline abdominal incision is made and the focus is approached retroperitoneally from the left side. However, when excessive scar tissue surround the infected focus and prevent adequate and safe retroperitoneal dissection, a transperitoneal approach is used.The surgical correction of kyphosis in the thoracolumbar and lumbar region is possible, but in the thoracic region this is not satisfactory from the anatomical point of view. In surgical correction of kyphosis, the author use Herbert's method via a posterior approach and concomitant focal curettage through an anterior approach.In paraplegic patients, the anterior radical operation has been carried out. The postopreative results have been well.
- 一般社団法人 国立医療学会の論文
一般社団法人 国立医療学会 | 論文
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