整块自体椎板棘突骨用于胸腰椎结核后路手术前中柱骨缺损修复重建的近期临床疗效  

Short-term effectiveness of anterior and middle columns repair and reconstruction with whole autogenous spinous process-laminar bone through posterior approach in thoracolumbar tuberculosis

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作  者:陈宏炜 李涛[1] 陈华[1] 修鹏[1] CHEN Hongwei;LI Tao;CHEN Hua;XIU Peng(Department of Orthopedics,Orthopedic Research Institute,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区:[1]四川大学华西医院骨科骨科研究所,成都610041

出  处:《中国修复重建外科杂志》2025年第2期201-208,共8页Chinese Journal of Reparative and Reconstructive Surgery

摘  要:目的探讨整块自体椎板棘突骨用于胸腰椎结核后路手术中前、中柱骨缺损修复重建的近期临床疗效。方法回顾分析2012年1月—2023年5月因胸腰椎结核采取后路手术并行前、中柱植骨重建的78例患者临床资料,其中采用整块自体椎板棘突骨移植38例(A组),自体结构性髂骨移植40例(B组)。两组患者性别、年龄、病程、结核累及节段及术前红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C reactive protein,CRP)、Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)、美国脊髓损伤协会(ASIA)分级、节段性后凸角及椎间高度等基线资料比较差异均无统计学意义(P>0.05)。记录并比较两组手术时间、术中出血量、术后引流量、住院时间、ESR、CRP、VAS评分、ODI、骨融合情况、ASIA评级改善情况、术后并发症及节段性后凸角变化和椎间高度变化。结果A组手术时间明显短于B组(P<0.05);两组术中出血量、术后引流量及住院时间比较差异无统计学意义(P>0.05)。两组患者均获随访,随访时间14~110个月,平均64.1个月;两组随访时间比较差异无统计学意义(P>0.05)。两组术后各时间点ESR、CRP、ODI、VAS评分均较术前显著改善,并随时间延长进一步改善,差异有统计学意义(P<0.05);组间比较除术后3 d A组VAS评分显著优于B组(P<0.05)外,两组各时间点各指标比较差异均无统计学意义(P>0.05)。两组骨融合时间比较差异无统计学意义(P>0.05)。绝大多数患者术后神经功能较术前改善,末次随访时两组ASIA分级比较差异无统计学意义(P>0.05)。各时间点两组间节段性后凸角和椎间高度差异,以及两组节段性后凸角和椎间高度矫正及丢失差异均无统计学意义(P>0.05)。A组发生1例手术切口脂肪液化、1例切口感染;B组发生1例下肢肌间深部静脉血栓,2例胸腔积液、10例取骨区疼痛;两组各有2例患者因高尿酸引发痛风;两组取骨�Objective To investigate the short-term effectiveness of the anterior and middle columns in thoracolumbar tuberculosis reconstructed with whole autogenous spinous process-laminar bone through posterior approach.Methods The retrospective study included 78 patients with thoracolumbar tuberculosis who underwent posterior approach surgery and anterior and middle column bone graft reconstruction between January 2012 and May 2023.Based on the type of autogenous bone graft used,patients were divided into group A(whole autogenous spinous process-laminar bone graft,38 cases)and group B(autogenous structural iliac bone graft,40 cases).There was no significant difference of baseline data,such as age,gender,disease duration,involved segment of spinal tuberculosis,and preoperative erythrocyte sedimentation rate(ESR),C reactive protein(CRP),Oswestry disability index(ODI),visual analogue scale(VAS)score,the American Spinal Injury Association(ASIA)grade,segmental kyphotic angle,and intervertebral height between the two groups(P>0.05).The operation time,intraoperative blood loss,postoperative drainage,hospital stays,ESR,CRP,VAS score,ODI,bone fusion time,ASIA grade for neurological status valuation,postoperative complications,change of segmental kyphotic angle,change of intervertebral height were recorded and compared between the two groups.Results The operation time in group A was significantly shorter than that in group B(P<0.05);there was no significant difference in intraoperative blood loss,postoperative drainage,and hospital stays between the two groups(P>0.05).All patients in the two groups were followed up 14-110 months(mean,64.1 months);there was no significant difference in the follow-up time between the two groups(P>0.05).The ESR,CRP,ODI,and VAS score at each time point after operation in both groups significantly improved when compared with those before operation,and further improved with the extension of time,the differences were significant(P<0.05).There was no significant difference between the two groups(P>0.05)ex

关 键 词:脊柱结核 骨缺损 脊柱稳定性 植骨 修复重建 

分 类 号:R687.3[医药卫生—骨科学]

 

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