前路颈椎结核病灶清除联合钛网与同种异体骨环支撑的临床疗效观察  

Clinical effects of anterior transplantation with allograft and titanium mesh in treatment of cervical tuberculosis

作　　者：王颖博 殷翔 刘鹏 赵建华 胡波 WANG Ying-bo;YIN Xiang;LIU Peng;ZHAO Jian-hua;HU Bo(Department of Spinal Surgery,Army Medical Center of PLA,Chongqing 400042,China)

机构地区：[1]解放军陆军特色医学中心脊柱外科

出　　处：《局解手术学杂志》2019年第6期446-450,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金(81501883)

摘　　要：目的探讨钛网与同种异体骨环支撑在颈椎前路病灶清除术中应用的安全性、有效性及临床疗效。方法回顾性分析2010年6月至2017年6月于我科行经前路颈椎结核病灶清除、钛网或同种异体骨环植骨融合内固定术治疗的23例颈椎结核患者的临床资料,将其分为同种异体骨环组(n=11)和钛网组(n=12)。对2组患者的手术时间、出血量、住院时间、ESR变化(红细胞沉降率)、植骨融合率、内植物塌陷情况进行比较。结果钛网组和同种异体骨环组手术时间、出血量、住院时间等指标差异无统计学意义(P>0.05)。同种异体骨环组术后3个月红细胞沉降率为(19.2±5.8)mm/h,钛网组术后3个月红细胞沉降率为(31.7±6.1)mm/h,差异有统计学意义(P<0.05)。随访1年,钛网组有5例出现内植物塌陷(5/12),同种异体骨环组出现1例内植物塌陷(1/11)。随访期间,1例患者因多重耐药结核菌抗结核治疗无效导致融合失败及内固定移位,2组其余患者均获得良好融合,无内固定移位及断裂。结论前路颈椎结核病灶清除术后钛网支撑及同种异体骨环支撑可取得满意的临床效果,移植物无明显排斥反应,均有较高的植骨融合率,但同种异体骨环具有较低的内植物塌陷率,可作为前路清除术后椎体结构缺损的理想替代材料用于颈椎结核的临床治疗。Objective To evaluate the safety,feasibility and the clinical effects of anterior transplantation with allograft and titanium mesh in the treatment of cervical tuberculosis.Methods From June 2010 to June 2017,the clinical data of 23 cases of cervical tuberculosis who were treated with allograft or titanium mesh combined with internal fixation after radical debridement in our department were analyzed retrospectively.All patients were divided into allograft group(n=11)and titanium mesh group(n=12).The operation time,amount of bleeding,hospital stays,ESR,graft fusion satisfaction rate and graft collapse rate between two groups were compared.Results The difference of the operation time,intraoperative blood loss and average length of hospital stay between two groups were not statistically significant(P>0.05).The mean ESR level was(19.2±5.8)mm/h in allograft group,and(31.7±6.1)mm/h in titanium mesh group at 3 months after the operation,the difference was statistically significant(P<0.05).There were 5 cases with graft collapse in titanium mesh group,1 case with graft collapse in allograft group.During the period of follow-up,all of patients showed bone graft fusion except 1 case of invalid for multidrug-resistant mycobacterium tuberculosis caused by anti-tuberculosis treatment.Conclusion The clinical effects of anterior transplantation with allograft and titanium mesh in the treatment of cervical tuberculosis is safety and feasibility without obvious graft rejection and high rate of bone graft fusion.Meanwhille,allograft maybe the ideal substitute of autologous iliac bone for the clinical treatment of cervical tuberculosis with low rate of graft collapse.

关 键 词：颈椎结核 同种异体骨 椎体融合内固定术 前路颈椎结核病灶清除 钛网 

分 类 号：R529.2[医药卫生—内科学] R681.5[医药卫生—临床医学]