载链霉素硫酸钙人工骨椎间孔镜下植入联合经皮置钉治疗腰椎结核  

Lumbar spinal tuberculosis implanted with artificial bone with streptomycin sulfate and percutaneous pedicle screw under transforaminal endoscopy

作　　者：付拴虎 秦凯 卢大汉 覃海飚[1] 谷金 陈勇喜[1] 覃浩然[1] 韦家鼎[1] 伍亮[1] 宋泉生[1] Fu Shuanhu;Qin Kai;Lu Dahan;Qin Haibiao;Gu Jin;Chen Yongxi;Qin Haoran;Wei Jiading;Wu Liang;Song Quansheng(First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023,Guangxi Zhuang Autonomous Region,China;People’s Hospital of Shangrao County,Shangrao 334100,Jiangxi Province,China)

机构地区：[1]广西中医药大学第一附属医院,广西壮族自治区南宁市530023 [2]江西省上饶县人民医院,江西省上饶市334100

出　　处：《中国组织工程研究》2021年第4期493-498,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:相关骨结核动物模型实验显示,通过硫酸钙人工骨载药可缓慢、持久地释放抗结核药物,增加局部药物浓度,同时其还可修复病灶局部骨缺损,促进骨性融合。目的:评价椎间孔镜下病灶清除后椎间隙植入载链霉素硫酸钙人工骨联合后路经皮椎弓根螺钉治疗腰椎结核的安全性及有效性。方法:选择2016年7月至2019年6月广西中医药大学第一附属医院收治的28例腰椎结核患者,其中男10例,女18例,年龄36-69岁,试验组12例接受椎间孔镜下病灶清除后椎间隙植入载链霉素硫酸钙人工骨联合后路经皮椎弓根螺钉内固定治疗,对照组16例接受前后联合入路下病灶清除植骨融合内固定或后路病灶清除植骨融合内固定治疗,记录手术时间、术中出血量与住院时间。术后3个月及末次随访时,对比两组血沉、C-反应蛋白水平及Cobb角、目测类比评分、腰椎JOA评分与Oswestry功能障碍指数评分。试验获得广西中医药大学第一附属医院理委员会批准。结果与结论:①试验组手术时间、术中出血量与住院时间均少于对照组(P<0.05);②两组术后3个月及末次随访的血沉、C-反应蛋白水平低于术前(P<0.05),试验组术后3个月的血沉、C-反应蛋白水平低于对照组(P<0.05);③两组术后3个月及末次随访的目测类比评分、Oswestry功能障碍指数评分低于术前(P<0.05),腰椎JOA评分均高于术前(P<0.05);试验组术后3个月的目测类比评分低于对照组(P<0.05);④两组术后的Cobb角均有丢失现象,两组间比较差异无显著性意义(P>0.05);⑤结果表明相比传统手术行后路、前后联合入路治疗腰椎结核,后外侧椎间孔镜下植入载链霉素硫酸钙人工骨联合后路经皮椎弓根螺钉内固定治疗腰椎结核同样可以达到满意的临床效果,同时又具有创伤小、恢复快等优势。BACKGROUND:Animal model experiments on bone tuberculosis showed that calcium sulfate artificial bone loading could slowly and permanently release antituberculosis drugs,increase local drug concentration,and repair local bone defects and promote bone fusion.OBJECTIVE:To evaluate the safety and efficacy of implantation of artificial bone with streptomycin sulfate and posterior percutaneous pedicle screw in the treatment of lumbar tuberculosis under transforaminal endoscopy after removal of lesions.METHODS:Twenty-eight patients with lumbar spinal tuberculosis who were treated in the First Affiliated Hospital of Guangxi University of Chinese Medicine from July 2016 to June 2019 were selected,including 10 males and 18 females,at the age of 36-69 years.Twelve patients in the experimental group received implantation of artificial bone with streptomycin sulfate and posterior percutaneous pedicle screw under transforaminal endoscopy after removal of lesions.Sixteen patients in the control group received bone graft fusion and internal fixation under anterior and posterior combined approach or bone graft fusion and internal fixation after posterior approach.Operation time,intraoperative blood loss,and hospital stay were recorded.At 3 months postoperatively and at the last follow-up,erythrocyte precipitation,C-reactive protein level and Cobb angle,visual analogue scale score,lumbar Japanese Orthopaedic Association score and Oswestry disability index score were compared between the two groups.The experiment was approved by the Ethics Committee of First Affiliated Hospital of Guangxi University of Chinese Medicine.RESULTS AND CONCLUSION:(1)The operation time,intraoperative blood loss and hospital stay in the experimental group were all less than those in the control group(P<0.05).(2)The erythrocyte sedimentation rate and C-reactive protein levels at 3 months after surgery and at the last follow-up in both groups were lower than those before surgery(P<0.05),while those in the experimental group were lower than those in the cont

关 键 词：骨 材料 人工骨 内固定 结核 椎间孔镜 经皮钉 腰椎结核 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学]