关键词: 结核,脊柱, 诊断显像, 体层摄影术,螺旋计算机, 外科手术, 预后, 评价研究

Abstract:

Objective To investigate the characteristics of preoperative multislice spiral computed tomography images (MSCT) in adult patients with active spinal tuberculosis with different outcomes.Methods A total of 242 adults patients with active spinal tuberculosis who underwent surgery in Guangzhou Chest Hospital from January 2015 to July 2018 were included in this retrospective study. They were divided into three groups according to the indexes of muscle strength, clinical symptoms and CT findings one year after operation: abnormal muscle strength group (Abnormal group; 33 cases), normal muscle strength with abnormal clinical symptoms group (Clinical abnormal group; 22 cases), postoperative normal group (Normal group; 187 cases). The MSCT features of the three groups before operation, including central vertebral body distribution, vertebral destruction degree, osseous spinal canal interruption, compression of the spinal canal and bilateral intervertebral foramen caused by lesions, and Cobb angle of lesion vertebral kyphosis, were analyzed.Results Preoperative MSCT showed that in the abnormal group, clinical abnormal group and normal group, the ratio of central vertebral bodies with obvious destruction in thoracic and thoracolumbar segment were 90.9% (30/33), 54.5% (12/22), and 56.7% (106/187); the ratio of central vertebral bodies with obvious destruction in lumbar and lumbosacral segment were 0.0% (0/33), 36.4% (8/22), and 36.4% (68/187); the ratio of central vertebral bodies with obvious destruction in anterior middle posterior columns were 19.4% (19/98), 21.6% (16/74) and 9.7% (57/587); the ratio of osseous spinal canal interruption were 24.2% (8/33), 27.3% (6/22), and 9.1% (17/187); and the ratio of obvious compression of vertebral canal caused by lesions were 100.0% (33/33), 77.3% (17/22), and 55.1% (103/187), and the ratio of obviously compressing bilateral intervertebral foramen were 87.9% (29/33), 72.7% (16/22) and 54.0% (101/187); and the ratio of calcium-like high-density compressive substances were 48.5% (16/33), 40.9% (9/22) and 18.7% (35/187), and it had significant difference in these aspects among the three groups (χ ² values: 14.28, 17.49, 14.33, 10.30, 26.40, 15.00, and 16.70, respectively; P values: 0.001, <0.001, 0.001, 0.006, <0.001, 0.001, and <0.001, respectively). The median (quartile) of kyphosis Cobb angle in the abnormal group, clinical abnormal group and normal group were 20.77 (18.40, 25.40)°, 21.01 (17.10, 22.77)°, and 15.63 (11.71, 19.61)°, respectively, and there were significant difference among groups (H=27.65, P<0.001).Conclusion Adult patients with active spinal tuberculosis might have poor prognosis and outcome if they have preoperative MSCT signs such as lesions located in thoracic and thoraco lumbar segment, three column destruction, interruption of osseous spinal canal, calcium-like high-density compressive substances with obvious compression of vertebral canal and bilateral foramen, and large kyphosis Cobb angle.

Key words: Tuberculosis,spinal, Diagnostic imaging, Cicatrix,hypertrophic, Surgical procedures, operative, Prognosis, Evaluation studies