多枚异形钛网一期后路修复脊柱结核  

Special formed titanium mesh cages for treating spinal tuberculosis via one-stage posterior approach

作　　者：阿不都乃比.艾力 张宏其[1] 黄卫民[2] 李磊[2] 田慧中[2] 

机构地区：[1]中南大学湘雅医院脊柱外科中心,湖南省长沙市410000 [2]新疆医科大学第六附属医院脊柱外2科,新疆维吾尔自治区乌鲁木齐市830000

出　　处：《中国组织工程研究》2016年第48期7192-7199,共8页Chinese Journal of Tissue Engineering Research

基　　金：新疆维吾尔自治区自然科学基金面上项目(2016D01C219)~~

摘　　要：背景:脊柱后路手术病灶清除后如何对前方的缺损区进行重建是修复手术的关键。作者计了与后路一期手术相匹配的异形钛网。目的:评估和观察异形钛网植骨联合后路一期手术治疗脊柱结核的临床可行性及安全性。方法:纳入自2009年7月至2011年6月应用多枚异形钛网植骨、一期后路手术治疗胸、腰椎及腰骶段结核患者共32例,其中胸段10例,胸腰段(T_(11)-L_2)8例,腰段10例,腰骶段4例。比较术前术后神经功能、胸腰椎结核后凸角度、疼痛目测类比评分、椎间隙高度、腰骶角及血沉变化,并观察手术时间、术中失血量、植骨融合情况。结果与结论:(1)手术时间平均为199 min,术中失血量平均为520 mL;(2)术后随访48-72个月。神经功能障碍的患者术后神经功能均有不同程度的改善;32例患者术后3个月血沉均恢复正常;终末随访时胸腰椎后凸角度、腰骶角和椎间隙高度均较术前明显改善(P<0.001)。术后2周患者疼痛目测类比评分较术前降低(P=0.001)。植骨融合时间平均7个月,术后2例患者伤口浅层感染并延迟愈合。无结核复发,亦无感染性脑脊髓膜炎和钛网沉降发生;(3)结果提示,单纯一期后路病灶清除联合多枚异形钛网植骨治疗病灶局限的脊柱结核是一种安全、有效、微创的修复方式,且可以更好的重建脊柱前柱稳定性。BACKGROUND： How to reconstruct the anterior defect after decomperation for posterior approach is the key of operation. We designed special formed titanium mesh cages matched with one-stage posterior approach surgery. OBJECTIVE： To evaluate and observe the clinical feasibility and safety of one-stage posterior internal fixation and interbody fusion with special formed titanium mesh cages in the treatment of spinal tuberculosis. METHODS： Thirty-two patients with thoracic, lumbar and sacral tuberculosis undergoing special formed titanium mesh cages from July 2009 to June 2011 were enrolled in this study, including 10 cases of thoracic segments, 8 cases of thoracic waist segments（T（11）-L2）, 10 cases of lumbar segments, and 4 cases of lumbar and sacral segments. Changes in neurological function, thoracic and lumbar spinal tuberculosis kyphosis, visual analogue scale score, intervertebral height, lumbosacral angle and erythrocyte sedimentation rate were compared before and after surgery. Operation time, intraoperative blood loss and graft fusion were observed. RESULTS AND CONCLUSION：（1） Average operation time was 199 minutes; intraoperative blood loss was 520 m L.（2） Postoperative follow-up was 48-72 months. Postoperative neurological function was improved to different degrees. Erythrocyte sedimentation rate recovered to normal 3 months after surgery in 32 patients. During final follow-up, kyphosis angle, lumbosacral angle and the height of intervertebral space were significantly improved（P〈0.001）. Visual analogue scale scores decreased 2 weeks after surgery（P=0.001）. All patients achieved bone fusion at 7 months averagely after surgery. Superficial wound infection occurred in two cases, and lately healed. No complications, such as tuberculosis, infectious meningitis or titanium mesh subsidence, occurred.（3） These findings confirmed that one-stage posterior internal fixation, debridement and interbody fusion with special formed titanium mesh cages can be a safe effective treatment

关 键 词：结核 脊柱 骨移植 疼痛测定 随访研究 组织工程 骨科植入物 脊柱植入物 脊柱结核 异形钛网 一期手术 新疆维吾尔自治区自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]