自体颗粒植骨修复椎骨缺损治疗单节段胸腰椎结核疗效研究  

Analysis on effect of autogenous granule bone graft repairing vertebral defect for treating single segment thoracolumbar spinal tuberculosis

作　　者：李剑箫 欧云生[1] LI Jianxiao;OU Yunsheng(Department of Orthopedics,First Affiliated Hospital of Chongqing Medically University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016

出　　处：《现代医药卫生》2018年第16期2445-2448,共4页Journal of Modern Medicine & Health

基　　金：国家自然科学基金面上项目(82572634)

摘　　要：目的探讨单纯后路病灶清除、自体颗粒植骨融合、椎弓根钉棒内固定治疗单节段胸腰椎结核的临床疗效。方法选取2014年6月至2016年8月该科治疗的单节段胸腰椎结核患者31例,采用自体颗粒骨行椎体间植骨修复椎骨缺损,术后定期随访评估结核治愈情况及植骨融合情况、局部后凸Cobb角和椎间高度变化;记录患者手术时间、术中出血量、住院时间;记录患者术前术后红细胞沉降率(ESR)、C反应蛋白(CRP)、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。结果术后随访VAS、ODI、ESR、CRP均较术前明显下降,差异均有统计学意义(P<0.05)。术后即刻及末次随访时Cobb角、椎间高度均较术前明显改善,差异均有统计学意义(P<0.05);而术后即刻与末次随访间2个指标比较,差异无统计学意义(P>0.05)。末次随访,11例术前存在神经功能损害的患者术后神经功能均得到改善,1例C级术后改善至D级,10例D级恢复至E级。结论应用椎体间自体颗粒植骨治疗单节段胸腰椎结核,是一种安全、可靠、有效的椎间植骨方式。Objective To investigate the clinical efficacy of simple posterior approach focal lesion debridement,autogenous granule bone graft fusion,and pedicle screw internal fixation for treating single segment thoracolumbar spinal tuberculosis.Methods Thirtyone patients with single segment thoracolumbar spinal tuberculosis in the orthopedic department of this hospital from June 2014 to June 2016 were selected.The autogenous granule bone grafting was adopted to repair vertebral defect.The postoperative regular follow up was performed to evaluate the tuberculosis cure situation,bone graft fusion situation and changes of local kyphosis Cobb angle and intervertebral height;the operative time,intraoperative bleeding volume and hospitalization duration were recorded.Preoperative and postoperative erythrocyte sedimentation rate(ESR),C?reactive protein(CRP),VAS score,Oswestry disability index(ODI)were recorded too.Results The scores of VAS and ODI,ESR and CRP at postoperative follow up were significantly decreased compared with before operation,the differences were statistically significant(P<0.05).The Cobb angle and intervertebral height instantly after operation and at last follow up were significantly improved compared with preoperation,the differences were statistically significant(P<0.05);but the comparison of the two indicators between instantly postoperative follow up and last follow up showed no statistical difference(P>0.05).At the last follow up,11 cases of preoperative neural function impairment were improved after operation,1 case of class C was improved to the class D and 10 cases of class D recovered to the class E.Conclusion Applying autogenous granule bone graft for treating single segmental thoracolumbar spinal tuberculosis is a reliable,safe,and effective way of intervertebral bone graft.

关 键 词：脊柱结核 后路手术 植骨 自体颗粒骨 

分 类 号：R687.3[医药卫生—骨科学]