脊柱后外侧同种异体骨植骨融合排异反应的临床诊断及治疗  

Clinical Diagnosis and Treatment of Bone Allograft Fusion Rejection in Posterolateral Spine

作　　者：李旭生[1] 梁强 雷建 王自立[1] 丁惠强[1] 赵浩宁[1] 乔永东[1] 袁海峰[1] LI Xusheng;LIANG qiang;LEI Jian;WANG Zili;DING Huiqiang;ZHAO Haoning;QIAO Yongdong;YUAN Haifeng(Department of spine surgery,the General Hospital of Ningxia Medical University,Yinchuan 750004,China;Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院脊柱外科

出　　处：《宁夏医科大学学报》2019年第8期804-808,共5页Journal of Ningxia Medical University

基　　金：国家自然科学基金(81660370);宁夏回族自治区重点研发计划项目(2016-25)

摘　　要：目的探讨同种异体骨行脊柱后外侧植骨融合后发生排异反应的临床诊断及治疗方案。方法回顾性分析我院2008年1月至2016年12月因外伤、退变、侧凸等采用同种异体骨行脊柱后外侧植骨融合后出现排异反应(观察组)和同期未发生排异反应患者(对照组)的临床资料,观察发生排异反应的时间、主要临床表现及临床处理后的愈后情况,比较两组患者术后体温、白细胞数、中性粒细胞比值、血沉及C反应蛋白(CRP)值。结果术后(4.2±2.2)d发生排异反应,观察组患者术后体温、白细胞、中性粒细胞比值、血沉及CRP值均高于对照组(P均<0.01)。17例发生排异反应的患者,给予抗菌药物预防感染、切口换药、加压包扎等临床处理,11例患者切口愈合;6例患者因切口周围组织失活,行清创缝合术,4例切口终获愈合;另2例患者经上述处理无效,最后行原手术切口植骨取出病灶清除术,取出全部植骨,切口愈合。结论发生同种异体骨植骨排异反应时,患者血沉及C反应蛋白明显升高,术区有大量淡黄色无菌性液渗出。经抗生素治疗、切口换药、加压包扎甚至“原切口植骨取出病灶清除术”等临床处理后,可促进切口可愈合。Objective To investigate the clinical manifestation,treatment and management of rejection of allogeneic bone after posterior bone graft fusion.Methods The clinical data of 17 cases of spinal lesions such as spinal trauma,degeneration and scoliosis who were treated by posterior bone grafting fusion from January 2008 to December 2016 were retrospectively analyzed.The operative time,clinical manifestations,postoperative body temperature,leukocyte number,neutrophils ratio,erythrocyte sedimentation rate and C-reactive protein were recorded and analyzed.The control group contains 30 patients without rejection after operation.Results The rejection occurred on(4.2±2.2) days after operation.The temperature,leukocyte,neutrophil ratio,erythrocyte sedimentation rate and C-reactive protein in the observation group were higher than those in the control group (P all<0.01).In 17 patients with rejection,treatment included antimicrobial drugs,wound dressing,pressurized dressing,incision of 11 patients healed,6 patients with tissue inactivation around the incision,the debridement were performed and 4 cases eventually healed;the other 2 patients were ineffective after the above treatment,finally were treated by“removal of primary surgical bone grafting ”,after removing of all bone grafts,the incision healed at last. Conclusion In the reaction of allogeneic bone grafting,the ESR and CRP of patients get to increase significantly,and there are a lot of yellowish aseptic liquid exudation in the operative area. Most patients are treated by antibiotic wound dressing,pressurized dressing and other clinical treatment,the incision finally get healed. If necessary,the“removal of primary surgical bone grafting”can be performed.

关 键 词：同种异体骨 排异反应 骨移植 脊柱手术 临床表现 

分 类 号：R681.5[医药卫生—骨科学]