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[1]章宏杰,李哲辰,王生淋,等.不同植骨方式在单节段胸腰椎结核手术中的对比研究[J].福建医科大学学报,2019,53(03):173-178.
 ZHANG Hongjie,LI Zhechen,WANG Shenglin,et al.Surgical Comparison of Different Bone Grafting Methods in Single-segment Thoracic and Lumbar Spinal Tuberculosis[J].Journal of Fujian Medical University,2019,53(03):173-178.
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《福建医科大学学报》[ISSN:1672-4194/CN:35-1192/R]

卷:
第53卷
期数:
2019年03期
页码:
173-178
栏目:
临床研究
出版日期:
2019-06-30

文章信息/Info

Title:
Surgical Comparison of Different Bone Grafting Methods in Single-segment Thoracic and Lumbar Spinal Tuberculosis
文章编号:
1672-4194(2019)03-0173-06
作者:
章宏杰 李哲辰 王生淋 韦 超 吴文策 林建华
福建医科大学 附属第一医院脊柱外科,福州 350005
Author(s):
ZHANG Hongjie LI Zhechen WANG Shenglin WEI Chao WU Wence LIN Jianhua
Department of Spine Surgery, The First Affiliated Hospital ofFujian Medical University, Fuzhou 350005, China
关键词:
结核 结核脊柱 胸椎 腰椎 髂骨 骨移植
Keywords:
tuberculosis tuberculosis spinal thoracic vertebrae lumbar vertebrae ilium bone transplantation
分类号:
R683; R687.3; R687.34
DOI:
-
文献标志码:
A
摘要:
目的 比较自体髂骨植骨、钛网植骨、Cage植骨3种不同植骨方式在单节段胸腰椎结核行后路手术中的临床应用效果。 方法 回顾性分析2011年2月-2016年7月行后路病灶清除内固定植骨融合手术并获完整随访的97例单节段胸腰椎结核患者的临床资料。依据不同植骨方式分为3组,其中A组(43例)采用自体髂骨植骨,B组(31例)采用钛网植骨,C组(23例)采用Cage植骨。对3组患者的平均手术时间、术中出血量、术中及术后当天血红蛋白、白蛋白丢失情况、疼痛视觉模拟评分(VAS)、神经功能分级(Frankel分级)、Cobb角、椎间高度、植骨融合情况及并发症进行对比。所有患者术前规范抗结核治疗至少2周,术后规范抗结核治疗1年以上。 结果 97例患者随访15~84月,所有患者结核完全治愈并获得植骨融合,95例患者术后神经功能均较术前有所改善。3组患者在术前、术后的疼痛评分、术中出血量、术中及术后当天血红蛋白丢失程度比较,差别无统计学意义(P>0.05); A组的手术时间长于B,C组(P<0.05); A组的术中、术后当天丢失的白蛋白情况显著高于B,C组(P<0.05); A组的Cobb角矫正度及恢复椎间高度能力小于B,C组(P<0.05)。A组的植骨融合时间与B组比较,差别无统计学意义(P>0.05),但均少于C组(P<0.05)。3组随访期间内固定在位、无松动,结核无复发,A组术后出现10例髂骨取骨区疼痛及2例髂骨取骨区切口感染,B组出现1例手术切口皮下积液。 结论 在单节段胸腰椎结核治疗中,3种植骨方式均可取得良好的疗效。钛网植骨、Cage植骨在缩短手术时间、减少白蛋白丢失及恢复脊柱矢状位序列及椎间高度具有优势,可避免取骨区并发症,但Cage植骨的骨融合有待提高。
Abstract:
Objective To compare the clinical efficacy of three different bone grafting methods, including autogenous iliac bone grafting, titanium mesh bone grafting and Cage bone grafting, in patients with single-segment thoracic or lumbar spinal tuberculosis through posterior approach. Methods The clinical data of 97 patients with single-segment thoracic or lumbar spinal tuberculosis was retrospectively analyzed. All the participants underwent posterior debridement surgery with internal fixation and bone grafting fusion between February 2011 and July 2016. Participants undergoing different bone grafting methods were divided into three groups, namely group A with 43 cases receiving autogenous iliac bone grafting, group B with 31 cases receiving titanium mesh grafting, and group C with 23 cases obtaining Cage bone grafting. In addition, characteristics among the three groups including mean operative time, blood loss, intraoperative and postoperative hemoglobin, albumin loss, visual analog scale(VAS), neurological function grading(Frankel grading), Cobb angle, intervertebral height, bone graft fusion, and complications were compared. All patients received anti-tuberculosis treatment for at least 2 weeks before surgery and 1 year after surgery. Results The follow-up time of 97 patients ranged from 15 to 84 months. All patients were completely cured and obtained solid bone fusion. Ninety-five postoperative patients obtained improved neurological function. No statistically significant difference was found when comparing the VAS, blood loss, intraoperative and postoperative hemoglobin loss among three groups(P>0.05). A longer operation time as well as more intraoperative and postoperative albumin loss were observed in group A compared with group B or group C(P<0.05). The Cobb correction and restoration of intervertebral height were significantly better improved in group B and group C compared with group A(P<0.05). The bony fusion time showed no significant difference between group A and group B(P>0.05), however it was shorter in group A and group B than that in group C(P<0.05). No loose or rupturing internal fixation, or recurrence of tuberculosis occurred to patients during the follow-up period, except for ten cases suffering chronic pain and 2 cases of incision infection at iliac donor sites in group A and 1 case with subcutaneous hydrops in group B. Conclusion In the treatment of single-segment thoracolumbar spinal tuberculosis,all three different bone grafting methods can achieve good results. Titanium mesh bone grafting or Cage bone grafting may effectively shorten operative time and decrease hemoglobin loss. It can maintain the spinal sagittal plane alignment and avoid the complication of autograft iliac bone fusion. Further research on bone fusion is needed.

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备注/Memo

备注/Memo:
收稿日期: 2018-08-15作者简介: 章宏杰,男,福建医科大学2016级临床医学专业硕士研究生通讯作者: 林建华.Email:jianhual@126.com
更新日期/Last Update: 2019-06-30