同种异体骨钛笼治疗脊柱结核3年随访研究  

A 3-year follow-up study on anterior debridement and reconstruction with allogeneic bone titanium cage for spinal tuberculosis

作　　者：王彦军 李立东[2] 刘弘扬[2] 于芳[2] 张洪[3] WANG Yan-jun;LI Li-dong;LIU Hong-yang;YU Fang;ZHANG Hong(Postgraduate School,Tianjin Medical University,Tianjin 300070,China;Department of Orthopedics,Tangshan Second Hospital,Tangshan 063500,China;Department of Orthopedics,Fourth Medical Center,PLA General Hospital,Beijing 100048,China)

机构地区：[1]天津医科大学研究生院,天津300070 [2]唐山市第二医院骨科,河北唐山063500 [3]解放军总医院第四医疗中心骨科,北京100048

出　　处：《中国矫形外科杂志》2021年第6期512-515,共4页Orthopedic Journal of China

摘　　要：[目的]探讨前路清创并同种异体骨钛笼治疗脊柱结核的长期疗效。[方法]回顾133例行前路彻底清创并同种异体骨钛笼植骨的胸腰椎脊柱结核患者,总结其围手术期、3年以上随访和影像资料。[结果]所有患者均顺利手术,未发生神经、血管损伤,手术时间(144.40±23.30) min,术中出血量(700.12±49.98) ml。所有患者平均随访(46.72±9.87)个月。完全负重活动时间为(8.71±2.25)周。随时间推移,133例的VAS评分显著下降(P<0.05),JOA评分显著增加(P<0.05),ASIA神经功能评级显著改善(P<0.05)。影像方面,与术前相比,术后6个月局部后凸Cobb角显著减少,差异有统计学意义(P<0.05);与术后6个月相比较,末次随访时局部后凸Cobb角稍有增加,但差异无统计学意义(P>0.05)。按Bridwell骨融合分类标准,随时间推移,椎间融合评级显著进步(P<0.05)。未次随访时,133例患者均未见笼架明显下沉,无内固定物松动。[结论]脊柱结核患者行彻底清创并同种异体骨钛笼植骨重建前柱,可提供即时稳定性,矫正后凸持久,临床效果满意。[Objective]To explore the long-term clinical outcomes of anterior debridement combined with reconstruction with allogeneic bone and titanium cage in the treatment of spinal tuberculosis. [Methods] A retrospective study was conducted on 133 patients who underwent anterior debridement and reconstruction with bone allograft filled titanium cage. The documents regarding to perioperative period,3 years of follow-up and images were summarized. [Results] All patients had successful operation without nerve and blood vessel injuries,while with operation time of(144.40±23.30) min, and the intraoperative blood loss of(700.12±49.98) ml. All patients were followed up for an average of(46.72±9.87) months. The full weight-bearing activity recovered in(8.71±2.25) weeks on average. The VAS score decreased significantly(P<0.05), whereas the JOA score increased significantly(P<0.05), and the ASIA neurological function grade significantly improved over time in the 133 patients(P<0.05). In terms of imaging assessment, the local kyphotic Cobb angle significantly reduced at 6 months after surgery compared with that preoperatively(P<0.05), while remained not significantly changed at the latest follow up compared with that at 6 months after surgery(P>0.05). According to the Bridwell’s bone fusion classification, the extent of intervertebral fusion improved significantly over time(P<0.05). At the latest follow-up, no remarkable subsidence of the cage, or internal fixation loosening was seen in anyone of the 133 patients. [Conclusion] This anterior debridement and reconstruction with bone allograft filled titanium cage does provide immediate stability, durable correction of kyphosis, and satisfactory clinical results for spinal tuberculosis.

关 键 词：脊柱结核 同种异体骨 钛笼 手术治疗 

分 类 号：R529.2[医药卫生—内科学]