同种异体骨支撑体修复脊柱结核骨缺损的疗效分析  

Analysis of the effect of allogeneic bone support body in repairing tuberculous bone defect of spine

作　　者：方德健[1] 李思贝 陈豪逸 许祖远[1] 钟鑫[1] 潘建超 张强[1] Fang Dejian;Li Sibei;Chen Haoyi(The Chest Hospital of Guangzhou City,Guangzhou,Guangzhou 510095)

机构地区：[1]广州市胸科医院,广东广州510095

出　　处：《基层医学论坛》2021年第23期3269-3272,F0003,共5页The Medical Forum

摘　　要：目的探讨同种异体骨支撑体联合自体骨植骨治疗脊柱结核骨缺损的临床疗效.方法选取2018年1月—2019年12月期间在广州市胸科医院行脊柱结核手术治疗的患者资料57例,均采用同种异体骨支撑体联合自体骨植骨.术后定期复查红细胞沉降率、C反应蛋白、X线影像、Cobb角及VAS评分,观察植骨块融合情况,神经功能恢复情况等,对临床疗效进行评价.结果植骨块融合时间为4~10个月,平均(6.7±2.4)个月.根据Bridwell骨融合标准,Ⅰ级45例(占78.9%),Ⅱ级10例(占17.5%),Ⅲ级2例(占3.6%),总体优良率(Ⅰ级和Ⅱ级融合)达96.4%.同种异体骨支撑体无明显免疫排斥反应,未出现明显下沉、移位及溶解,内固定未见松动或断裂情况.术前合并截瘫的患者共8例,根据Frankel分级,B级3例,其中1例术后恢复至D级,1例术后恢复至E级,1例术后未有恢复;C级1例,术后恢复至D级;D级4例,全部术后恢复至E级.57例患者ESR术后2周为(29.00±18.07)mm/1h,末次随访为(7.46±5.12)mm/1h,分别与术前(49.70±20.44)mm/1h比较,差异有统计学意义(P<0.05);CRP术后2周为(9.45±8.58)mg/L,末次随访为(3.44±2.44)mg/L,分别与术前(34.17±17.99)mg/L比较,差异有统计学意义(P<0.05);Cobb角术后2周为(9.85±4.47)°,末次随访为(10.15±4.86)°,分别与术前(17.80±7.17)°比较,差异有统计学意义(P<0.05);VAS评分术后2周为(1.51±0.91)分,末次随访为(0.58±0.59)分,分别与术前(6.49±1.40)分比较,差异有统计学意义(P<0.05).结论同种异体骨支撑体联合自体骨植骨内固定能最大限度地修复胸腰椎结核病灶清除术后骨缺损,重建脊柱的稳定性和支撑功能.Objective To evaluate the ulitilization of allograft support combined autologous bone graft and internal fixation in tuberculosis spinal fusion surgery.Methods Fifty seven patients treated with tuberculosis surgery in Guangzhou Chest Hospital from January 2018 to December 2019.All patients were treated with one-stage anterior approach debridement and fusion surgery was performed with allograft strut combined autograft insertion,then to internal fixation.Parameters including CRP,Cobb angle,VAS,fusion rate and neurological function were recorded peri-operation.Results All cases were recorded fusion at the final follow-up.The intervertebral fusion time were from 3 to 10 months,with average 6.7±2.4 months.According to Bridwell standard,there were 45 cases of LevelⅠ(78.9%),10 cases of LevelⅡ(17.5%),2 cases of LevelⅢ(3.6%),while overall excellent rate was 96.4%.There were 8 pre-operation paraplegia cases.According to Frankel standard,there were three B rank cases containing one D rank recovery,one E rank recovery and one case remained;All four D rank cases were recovered to E rank.Among fifty patients,significantly decreased was shown on ESR(Pre-operation 49.70±20.44 mm/h,2 weeks post-operation 29.00±18.07 mm/h;P<0.05),CRP(Pre-operation 34.17±17.99 mg/L,2 weeks post-operation 9.45±8.58 mg/L,and finally 3.44±2.44 mg/L;P<0.05)and Cobb angle(Pre-operation 17.80±7.17°,2 weeks post-operation 9.85±4.47°,and finally 10.15±4.86°;P<0.05).Conclusion Allograft strut combined autograft insertion with internal fixation can restore the spinal defect of thoracolumbar tuberculosis debridement,and rebuild the spinal stability.

关 键 词：胸腰椎结核 骨缺损 同种异体骨 支撑体 植骨融合 

分 类 号：R4[医药卫生—临床医学]