三种植骨材料在治疗骶髂关节结核的应用  

Treatment of sacroiliac joint tuberculosis with local bone grafting using three implanted bone materials

作　　者：郜振武 冯皓宇 马永壮 席镭民 曹凯 陈旭 GAO Zhen-wu;FENG Hao-yu;MA Yong-zhuang;XI Lei-min;CAO Kai;CHEN Xu(Orthopedics Department,Shanxi Bethune Hospital,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西白求恩医院骨科,山西太原030001

出　　处：《颈腰痛杂志》2024年第2期335-339,357,共6页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的比较自体骨、人工骨和载药硫酸钙植骨融合治疗骶髂关节结核患者的临床疗效。方法回顾性收集2016年4月~2020年4月间在本院骨科住院并手术治疗的骶髂关节结核患者的临床资料。根据术中应用的植骨材料不同,将患者分为人工骨植骨组、自体骨植骨组、载药硫酸钙植骨组。随访观察≥24个月,对比治疗前后的影像学检查(骶髂X线片和CT扫描)结果,对植骨融合时间与状况、疼痛变化进行评定和分析。采用Majeed骨盆评分评价骶髂关节功能。结果自体骨植骨组患者的手术时间和术中出血量均明显高于人工骨植骨组、载药硫酸钙植骨组(P<0.05)。三组术后6个月植骨融合率对比,差异有统计学意义(P<0.05),其中自体骨植骨组优于载药硫酸钙植骨组和人工骨植骨组;在术后9个月对比,差异无统计学意义(P>0.05),三组患者术后12个月均获植骨融合。三组Majeed骨盆评分比较,差异有统计学意义(P<0.05),载药硫酸钙植骨组优于人工骨植骨组、自体骨植骨组。三组患者术后12 h、术后1 d、术后3 d的VAS评分均较术前1 d显著上升。人工骨植骨组、载药硫酸钙植骨组术后12 h、术后1 d、术后3 d的VAS评分均显著低于自体骨植骨组,差异有统计学意义(P<0.05)。三组患者均未见明显术后并发症发生。结论自体骨有着更高的早期植骨融合率,人工骨、载药硫酸钙植骨的手术时间更短、手术创伤更低且术后疼痛更轻;载药硫酸钙植骨在Majeed骨盆评分中最好。临床实践中,可根据患者骨量、耐受度、关节功能恢复要求来选择合适的植骨方式。Objective To compare the effects of autogenous bone graft,artificial bone graft fusion and drug-loaded calcium sulfate bone graft fusion in patients with sacroiliac joint tuberculosis.Methods The clinical data of patients with sacroiliac joint tuberculosis who were hospitalized and operated in our hospital from April 2016 to April 2020 were retrospectively collected.According to the different bone grafting materials,the patients were divided into artificial bone grafting group,autogenous bone grafting group and drug-loaded calcium sulfate bone grafting group.The patients were follow-up for at least 24 months to observe the recovery of symptoms,then the results of imaging examination(sacroiliac X-ray film and CT scan)were compared before and after treatment,and bone graft fusion time and status and the pain changes were evaluated and analyzed.The function of sacroiliac joint was evaluated by Majeed pelvic score.Results The operation time and blood loss of autogenous bone graft was significantly longer and more than that of artificial bone graft group and calcium sulfate-loaded bone graft group(P<0.05).Six months after operation,the difference in the fusion rate of bone graft among the three groups was statistically significant(P<0.05),and the fusion rate of autogenous bone graft group was higher than that of the drug-loaded calcium sulfate bone graft group and the artificial bone graft group.There was no significant difference in the fusion rate nine months after operation(P>0.05),and all groups of patients got bone graft fusion 12 months after operation.The difference in Majeed pelvic scores of the three groups was statistically significant(P<0.05),and the score of drug-loaded calcium sulfate bone graft group was superior to that of the artificial bone graft group and the autogenous bone graft group.The VAS scores of patients in three groups increased 12 h,1 d and 3 d after operation compared with those 1 d before operation.The VAS scores of artificial bone graft group and drug-loaded calcium sulfate bone graft g

关 键 词：骶髂关节 结核杆菌 载药硫酸钙植骨 自体骨植骨 人工骨 

分 类 号：R529.2[医药卫生—内科学]