四种椎间植骨融合方式治疗化脓性脊柱炎的临床对比研究  

Clinical comparative study of four kinds of intervertebral bone graft fusion in treatment of pyogenic spondylitis

作　　者：张毕 方军 吴健 张斌[3] 陈云生 陈荣春 ZHANG Bi;FANG Jun;WU Jian;ZHANG Bin;CHEN Yunsheng;CHEN Rongchun(Department of Spinal Surgery,Ganzhou People's Hospital,Ganzhou,Jiangxi 341000,China;不详)

机构地区：[1]赣州市人民医院(南昌大学附属赣州医院)脊柱外科,江西341000 [2]上犹县人民医院骨科,江西赣州341200 [3]南昌大学第一附属医院骨科,江西南昌330006

出　　处：《中国骨与关节损伤杂志》2024年第5期454-462,共9页Chinese Journal of Bone and Joint Injury

摘　　要：目的 对比研究采用四种椎间植骨融合方式治疗化脓性脊柱炎的临床疗效。方法 纳入自2016-01-2022-11于笔者所在医院采用一期后路病灶清除+椎间植骨融合内固定手术治疗的106例胸腰椎化脓性脊柱炎,比较自体髂骨(A组)、自体髂骨+异体骨(B组)、自体髂骨填充钛笼(C组)、自体髂骨填充聚醚醚酮椎间融合器(D组)四种植骨融合方式的临床疗效。比较四组术前一般情况、手术及住院情况、感染指标控制情况、术后临床疗效指标、术后影像学指标。结果 所有患者均获得随访,随访时间12~20个月,平均16.5个月。四组手术时间、术中出血量、术后引流量、住院天数比较,差异无统计学意义(P>0.05)。四组住院费用比较,差异有统计学意义(P<0.05);住院费用由低到高为A组<B组<C、D组。四组术前以及术后7天、1个月、3个月C-反应蛋白、红细胞沉降率、白细胞计数、降钙素原比较,差异均无统计学意义(P>0.05)。四组术后感染复发率比较,差异无统计学意义(P>0.05)。四组术前以及术后1个月、6个月、12个月疼痛VAS评分、JOA评分、ODI指数比较,差异均无统计学意义(P>0.05)。四组术后12个月ASIA分级情况比较,差异无统计学意义(P>0.05)。四组术前、术后、末次随访时Cobb角比较,差异均无统计学意义(P>0.05)。四组Cobb角差值、Cobb角纠正度、植骨融合率、植骨融合时间、植骨材料下沉率比较,差异均无统计学意义(P>0.05)。结论 化脓性脊柱炎患者在病灶彻底清除、牢靠的脊柱融合内固定装置及规范有效的抗感染治疗的前提下,采用自体髂骨、自体髂骨+异体骨、自体髂骨填充钛笼、自体髂骨填充聚醚醚酮椎间融合器四种椎间植骨融合方式均安全有效。Objective To compare the clinical efficacy of four different interbody fusion methods for the treatment of pyogenic spondylitis.Methods From January 2016 to November 2022,a total of 106 cases of thoracolumbar pyogenic spondylitis were treated with one-stage posterior lesion clearance and interbody fusion fixation surgery at our hospitals.The clinical efficacy of four bone graft fusion methods was compared:autogenous iliac bone(group A),autogenous iliac bone combined with allograft(group B),autogenous iliac bone filled titanium cage(group C),and autogenous iliac bone filled polyetheretherketone intervertebral fusion device(group D).Results All patients were followed up for 12 to 20 months,with an average of 16.5 months.There were no statistically significant differences in surgical time,intraoperative blood loss,postoperative drainage volume,and length of hospital stay among the four groups(P>0.05).However,there was a statistically significant difference in hospitalization costs among the four groups(P<0.05),with group A having the lowest costs followed by group B and then groups C and D.There were no statistically significant differences in preoperative and postoperative levels of C-reactive protein,erythrocyte sedimentation rate,white blood cell count,or calcitonin between the four groups at 7 days,1 month,and 3 months after surgery(P>0.05).The incidence of postoperative infection recurrence did not differ significantly among the four groups(P>0.05).There were no statistically significant differences in pain VAS scores at 1 month,6 months,and 12 months after surgery as well as JOA scores and ODI index between the four groups(P>0.05).The ASIA classification at 12months after surgery also showed no statistically significant differences among the four groups(P>0.05).The Cobb angle measurements before and after surgery,and at last followup did not show any statistically significant differences among the four groups(P>0.05).The Cobb angle difference,Cobb angle correction rate,bone fusion rate,bone fusion time and bon

关 键 词：化脓性脊柱炎 椎间融合 植骨材料 

分 类 号：R687.3[医药卫生—骨科学]