前方双钛网支撑植骨联合后方椎弓根内固定重建腰椎结核患者的脊柱稳定性  

Spinal stability in patients with lumbar spinal tuberculosis with anterior double titanium mesh support bone grafting and posterior pedicle screw fixation

作　　者：尹振宇 宋晋刚 崔易坤 蒲劲松[2] Yin Zhenyu;Song Jingang;Cui Yikun;Pu Jinsong(Department of Spinal Surgery,Mianyang Central Hospital,Southwest Medical University,Mianyang 621000,Sichuan Province,China;Department of Orthopedics,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan Province,China)

机构地区：[1]西南医科大学绵阳市中心医院脊柱外科,四川省绵阳市621000 [2]川北医学院附属医院骨科,四川省南充市637000

出　　处：《中国组织工程研究》2020年第15期2355-2360,共6页Chinese Journal of Tissue Engineering Research

基　　金：四川省卫生和计划生育科研课题项目(17PJ201)，项目负责人：蒲劲松~~

摘　　要：背景:常规前路病灶清除并植骨融合内固定治疗腰椎结核对患者的创伤大,且造成的并发症较多,而双钛网支撑植骨联合后方椎弓根内固定重建手术治疗可明显改善患者预后,但目前尚无临床研究对比这两种方法治疗效果的差异。目的:对比腰椎结核经前方双钛网支撑植骨联合后方椎弓根内固定和常规前路病灶清除并植骨融合内固定治疗效果的差异。方法:回顾性收集2015年5月至2018年3月西南医科大学绵阳市中心医院脊柱外科收治的腰椎结核患者40例的病历资料,按照治疗方案分为2组,每组20例,试验组以前方双钛网支撑植骨联合后方椎弓根内固定治疗,对照组以前路病灶清除并植骨融合内固定治疗。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。结果与结论:①两种方法均可以有效治疗腰椎结核;②与对照组相比,试验组手术时间较短,术中出血量较少,且植骨融合较快;③随术后时间的延长,2组患者的红细胞沉降率以及病变节段的矢状面Cobb角逐渐降低,且试验组红细胞沉降率和病变节段的矢状面Cobb角略低于对照组;④经治疗后部分患者的美国脊髓损伤协会分级有所改善;⑤试验组不良反应发生率低于对照组;⑥提示双钛网支撑植骨联合后方椎弓根内固定重建可有效改善病椎的稳定性,且对于腰椎结核的治疗效果优于常规前路病灶清除并植骨融合内固定。BACKGROUND:Conventional anterior debridement and bone graft fusion for lumbar spinal tuberculosis have a great trauma,and bring more complications.The double titanium mesh support bone graft combined with posterior pedicle internal fixation reconstruction can significantly improve the prognosis of lumbar spinal tuberculosis.There is no clinical study to compare the efficacy between the two surgical methods.OBJECTIVE:To compare the efficacy of lumbar spinal tuberculosis via anterior double titanium mesh support bone graft combined with posterior pedicle internal fixation and conventional anterior debridement and bone graft fusion.METHODS:Case history data of 40 patients with lumbar spinal tuberculosis were retrospectively collected from the Department of Spinal Surgery,Mianyang Central Hospital,Southwest Medical University from May 2015 to March 2018.The patients were divided into experimental group and control group(n=20)according to the operation.Patients in the experimental group were treated with the anterior double titanium mesh support bone graft combined with the posterior pedicle screw fixation reconstruction.Patients in the control group were treated with anterior debridement and bone graft fusion.All patients signed the informed consent.This study was approved by the Hospital Ethics Committee.RESULTS AND CONCLUTION:(1)Lumbar spinal tuberculosis could be effectively treated with both surgical methods.(2)Compared with the control group,the operation time was shorter;the intraoperative blood loss was less;and the bone graft fusion was faster in the experimental group.(3)With prolongation of the postoperative time,the erythrocyte sedimentation rate and the sagittal Cobb angle of the lesion segment gradually decreased in the two groups.The erythrocyte sedimentation rate and the sagittal Cobb angle of the lesion segment in the experimental group were slightly lower than those in the control group.(4)After treatment,the classification of the American Spinal Cord Injury Association was improved in some patients.

关 键 词：腰椎结核 钛网 植骨 椎弓根螺钉 内固定 腰椎重建 COBB角 美国脊髓损伤协会分级 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]