The changes of the Kyphosis of the Tuberculous Spine in Children following Ambulatory Treatment / 대한정형외과학회잡지

Tuberculosis of the spine still remains as an important problem and also have high incidence in children in Korea. Many cases of the tuberculous spine are complicated by deformities of the spine and disability such as paraplegia, incordination of the cardio-pulmonary function and also result in early death. For the treatment of the tuberculous spondylitis following measure should be considered. First, eradication of the tuberculous lesion by conservative treatment or combined surgery, secondly, prevention of the deformity of the spine. Lastly, care for physical and psycological or emotional changes, and care for cardio-pulmonary dysfunction which develops after establishment of spinal deformity. Authors also attempted to analyse the kyphotic changes of the tuberculous spine of 70 children who were ambulating treatment at Pusan University Hospital and Pusan Charity Hospital, and obtained the result as follows; 1. Lower thoracic and upper lumbar were mostly involved. Nearly all cases of the new involvement of adjacent vertebra within 18 months. Only 4 cases now involvement occured after 18 months. 3. Kyphosis aggrevated grossly in 61.3% of cases. Most of them were apparent within 18 months but the changes developed after 18 months in 4.23% of cases. 4. In measuring the radiological kyphosis, Salters angle usually more simpler one than the internal gibbus angle. 5. Salters angle was larger involved than the internal gibbus angle except in mild and severe cases of the lumbar and lumbosacral involvement. Increase of kyphosis was 13.6 degree by internal gibbus angle and 16.3% by Salters angle. Kyphosis increased after 18 months were 3.1 degree by internal gibbus angle and 5.0 degree by Salters angle. 6. Radiological kyphosis changed in all stages and at least we should consider the changes of the kyphosis could be measured. 7. By the Kawakamis spinometer, the compensatory curvature, the posture of the patient and state of the kyphosis could be measured. 8. The compensatory curvature measured by Kawakamis spinometer were as follows: a) compensatory curvature in decrement in mild or morderate degree of cases, changed lumbar only or both cervical and lumbar curvature. b) compensatory curvature in increment in severe thoracic involvement changed both cervical and lumbar curvature, or cervical one only, the value in the cervical one was larger than that in the lumbar curvature.

A Study on the Change of the Kyphosis of the Tuberculous Spine in Children following Ambulatory Treatment (II. Kyphosis and Pulmonary Function) / 대한정형외과학회잡지

Tuberculous spine has high incidence in children. Many cases of the tuberculous spine are complicated by deformities of the spine and disability such as paraplegia, cardio-plumonary dysfunction, and also early death. There are now several reports on the pulmonary dysfunction due to spinal deformities such as scoliosis and kyphoscoliosis, but there are few papers on the pulmonary function of patients with the tuberculous spine and kyphosis in children. This article is a report on the study of chest excursion in 70 kyphotic children and of the pulmonary function in 10 cases of severe kyphotic patients with collapsing tuberculous spine. The following results are obtained through the study: 1) Chest excursion was evidently diminished in the cases of moderate and severe thoracic, and severe lumbar involvement. The remainders were nearly within normal limits. 2) The study revealed that the chest excursion and the radiological kyphosis has a very gradually sloped negative correlation in thoracic involvement. 3) Pulmonary function in the severe kyphotics who had the curve over 50 degree were revealed as follows; a) Over 50 percent of the cases had diminished vital capacity. That is, over-all average was 67.7 percent of normal capacity. Especially inspiratory reserve volume was diminished, it was 63.7 percent of normal. Maximum breathing capacity was 68.8 percent of normal. b) Tidal volume, timed vital capacity, minute ventilation rate and O2 consumption were within normal limits or nearly normal.