钛网及同种异体骨植骨结合内固定治疗脊柱结核:23例随访验证  

Titanium mesh cage and allogenic bone for treating thoracic and lumbar tuberculosis in 23 patients:A follow-up study

作　　者：谷守山[1] 李永民[1] 王旭[1] 李颉[1] 

机构地区：[1]唐山市第二医院,河北省唐山市063000

出　　处：《中国组织工程研究与临床康复》2010年第30期5662-5665,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景：植骨内固定治疗脊柱结核容易出现植骨块滑移、骨折、吸收或突入椎管引起神经症状,从而导致脊柱不稳。钛网为强度非常高的圆桶状,其边缘以锯齿状与椎体接触,具有显著防滑移作用。目的：探讨钛网植入内固定结合同种异体骨植骨治疗胸腰椎脊柱结核的临床效果。方法：选择胸腰椎结核患者23例,男12例,女11例,年龄13~55岁。采用一期病灶清除,前和/或后路椎弓根系统置入内固定,钛网及同种异体骨联合应用植入治疗,术后观察伤口愈合、结核中毒症状及神经功能恢复,固定融合及复发情况。结果与结论：23例患者获得1~3年随访,伤口均一期愈合,结核中毒症状明显改善或消失,神经功能完全恢复,内固定无松动、断裂,植骨无移动、折断、吸收,无后突畸形发生,固定融合情况良好,无结核复发迹象,6~12周带支具下床活动,6个月恢复正常生活及工作。证实脊柱结核病灶一期清除后,应用钛网及同种异体骨植骨结合内固定置入治疗能使脊柱获得即刻及远期的稳定,纠正后凸畸形,促进椎体间植骨融合,是目前治疗脊柱结核的一种安全有效的治疗方法。BACKGROUND：Grafts slip,fracture,absorbed or intruded into the spinal canal is easy to appear during the treatment of spinal tuberculosis.The shape of titanium mesh cage is high intension tubbiness,and the zigzag edge contacts with the vertebra.This shape can prevent materials slippage observably.OBJECTIVE：To evaluate the clinical value of combined application of titanium mesh cage and allogenic bone for treating thoracic and lumbar tuberculosis.METHODS：The 23 cases of thoracic and lumbar tuberculosis including 12 males and 11 females,aged 13-55 years,were retrospectively analyzed.Operative methods,including one-stage anterior radical debridement,anterior and/or posterior fixation and allogenic bone fusion with titanium mesh cages,were used.Postoperative incision concrescence,recovery of tuberculosis symptoms and neurologic function,bone fusion and the recurrence of spinal tuberculosis were observed.RESULTS AND CONCLUSION：All patients were visited regularly after operation for 1-3 years.The incision became healed for the first stage.The tuberculosis symptoms were significantly improved or disappeared.No titanium mesh allogenic bone fusion or fixation failure,no spinal kyphosis was observed.After operation,all patients got exercises out of bed by wearing orthosis 6-12 weeks later and did normal work 6 months later.It can be verified that the one-stage anterior radical debridement,reconstruction with titanium mesh cages and allogenic bone combined segmental fixation is an effective method in the treatment of thoracic and lumbar tuberculosis.It allows spine to obtain immediate and long-dated stability,correct kyphosis and promotes bone grafting fusion.

关 键 词：脊柱结核 钛网 内固定 同种异体骨 硬组织植入物 

分 类 号：R318[医药卫生—生物医学工程]