髂骨与钛网支撑植骨治疗胸、腰椎结核的疗效对比  

A Comparative Study of the Effect of Ilium and Titanium Mesh Strut Graft in the Treatment of Thoracolumbar Tuberculosis

作　　者：拓一帆 吴继德 胡利红[2] 李旭生[2] 杨生森 乔永东[2] 袁海峰[2] TUO Yifan;WU Jide;HU Lihong;LI Xusheng;YANG Shengsen;QIAO Yongdong;YUAN Haifeng(Ningxia Medical University,Yinchuan 750004,China;General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学,银川750004 [2]宁夏医科大学总医院,银川750004

出　　处：《宁夏医科大学学报》2023年第6期619-625,共7页Journal of Ningxia Medical University

摘　　要：目的比较髂骨支撑植骨与钛网支撑植骨在胸、腰椎结核稳定性重建中的远期疗效。方法筛选2000年4月至2008年1月行后路固定、前路清除术后植骨治疗的胸、腰椎结核患者共87例。其中44例患者采用自体髂骨植骨(髂骨组),43例患者采用钛网植骨(钛网组)。比较两组患者平均手术时间、失血量、住院时间、视觉模拟评分(VAS)、功能障碍指数(ODI)、红细胞沉降率(ESR)、C反应蛋白(CRP)、骨融合时间及相关并发症。采用Frankel分级评估神经功能,用Cobb角和矫正角度丢失评估脊柱畸形的改善。结果随访10~18年(平均13.4年),髂骨组与钛网组在平均手术时间、失血量、住院时间比较,差异均无统计学意义(P均>0.05)。术后髂骨组与钛网组VAS、ODI、ESR和CRP水平较术前均下降(P均<0.05),但术后两组间差异均无统计学意义(P均>0.05)。髂骨组术后(5.3±0.7)个月,钛网组术后(5.5±1.5)个月达骨性融合,两组间差异无统计学意义(P>0.05)。两组患者术后Cobb角较术前均改善(P均<0.05)。末次随访时,钛网组的内植物下沉率和后突矫正度数丢失均高于髂骨组(P均<0.05)。所有患者神经功能均得到改善,无内固定失败,无脊柱结核病灶复发。结论胸、腰椎脊柱结核行后路固定、前路彻底病灶清除术后,采用髂骨或钛网重建前方稳定性临床远期疗效相当,但钛网作为前中柱重建的材料,有发生钛网下沉和脊柱后突矫正度数丢失的风险。Objective To compare the long-term efficacy of autogenous iliac bone graft and titanium mesh bone graft in stability reconstruction of spinal tuberculosis.Methods A total of 87 patients with thoracolumbar tuberculosis underwent posterior internal fixation followed by anterior radical debridement and bone graft fusion from April 2000 to January 2008 were selected.44 patients received autogenous iliac bone graft(AIBG group)and 43 patients received titanium mesh bone graft(TM group).The mean of operation time,blood loss,ESR,CRP,visual analogue scale(VAS),oswestry disability index(ODI),graft fusion time and related complications were compared between the two groups.Frankel grading system,Cobb angle,and loss of angular correction were employed to assess neurological and kyphotic improvements.Results The mean follow-up time was 13.4 years,ranging from 10 to 18 years.No significant differences were found in the mean of operation time,blood loss and hospitalization time between the groups(P all>0.05).The VAS,ODI,ESR and CRP were reduced significantly at the postoperative compared with the preoperation values(P all<0.05),and there was no significance between the groups(P all>0.05).Bone fusion was achieved at(5.3±0.7)months after surgery in AIBG group and(5.5±1.5)months after surgery in TM group,with no significant difference between the two groups(P>0.05).All patients showed significant improvement in Cobb angles after surgery(P all<0.05).At the final follow-up,the implant subsidence rate and the loss of angular correction in TM group were significantly higher than those in AIBG group(P all<0.05).Neurological deficits were improved in all patients at the final follow-up,and no implant failure and no STB recurrence.Conclusion After posterior internal fixation and complete anterior debridement of thoracolumbar tuberculosis,the reconstruction of anterior stability with autogenous iliac bone graft or titanium mesh bone graft has no significant effect on the long-term clinical efficacy.However,there is a risk of implant subs

关 键 词：脊柱结核 髂骨植骨 钛网植骨 内固定 

分 类 号：R529.2[医药卫生—内科学]