摘要
目的通过与自体骨比较,评价同种异体骨在颈椎结核前路椎间植骨融合中的疗效。方法 2000年1月-2008年1月,对30例下颈椎结核行前路彻底清除病灶、植骨及内固定术,根据植骨材料不同,分为同种异体冷冻干燥骨组(A组)和自体髂骨组(B组)。A组15例,男8例,女7例;平均年龄38岁。病程6～14个月。术前后凸Cobb角(8.6±11.3)°,神经功能按日本骨科协会(JOA)评分为(13.0±3.1)分;术中植骨长度平均32 mm。B组15例,男9例,女6例;平均年龄42岁。病程4～17个月。术前后凸Cobb角(4.9±7.4)°,JOA评分为(12.3±4.2)分;术中植骨长度平均34 mm。两组患者一般资料比较差异均无统计学意义(P>0.05),有可比性。结果 A组手术时间及术中出血量均少于B组,比较差异有统计学意义(P<0.05)。A组术后2例切口渗液,其余患者切口均Ⅰ期愈合;B组无感染发生,切口均Ⅰ期愈合。A组13例获随访,随访时间12～48个月;B组14例获随访,随访时间13～46个月。A组植骨融合时间为(7.6±2.1)个月,与B组(4.2±1.1)个月比较差异有统计学意义(t=2.773,P=0.005)。两组术后6个月及末次随访时后凸Cobb角均较术前明显改善,差异有统计学意义(P<0.05);术后各时间点两组间后凸Cobb角比较差异均无统计学意义(P>0.05)。术后6个月两组JOA评分分别为(14.1±2.6)分和(14.3±2.4)分,比较差异无统计学意义(t=1.655,P=0.162)。A、B组术后有效改善率分别为83.7%和87.8%,差异无统计学意义(χ2=3.150,P=0.071)。两组内固定物均牢靠无松动,随访期间均无结核复发。B组5例出现髂骨取骨区疼痛。植骨融合采用Bridwell等的标准评价,A组满意11例(84.6%),不满意2例(15.4%);B组满意14例(100%);A、B组植骨融合满意率比较差异无统计学意义(χ2=2.680,P=0.115)。结论与自体骨相比,同种异体骨在颈椎结核前路植骨融合中疗效满意,可有效修复颈椎结核病灶清除术后的骨缺损。
Objective To evaluate the clinical results of allogeneic bone graft for interbody fusion in cervical tuberculosis.Methods Between January 2000 and January 2008,30 cases of cervical tuberculosis were treated with allogeneic（group A,n=15） or autologous（group B,n=15） iliac crest bone graft combined with anterior fixation after radical debridement.In group A,there were 8 males and 7 females with an average age of 38 years;the disease duration was 6 to 14 months;the preoperative kyphosis Cobb angle was（8.6 ± 11.3）°;the preoperative Japanese Orthopaedic Association（JOA） score was 13.0 ± 3.1 for neurological function;and the length of bone graft was 32 mm on average.In group B,there were 9 males and 6 females with an average age of 42 years;the disease duration was 4 to 17 months;the preoperative kyphosis Cobb angle was（4.9 ± 7.4）°;the preoperative JOA score 12.3 ± 4.2;and the length of bone graft was 34 mm on average.There was no significant difference in general data between 2 groups（P 0.05）.Results The operation time and bleeding volume in group A were significantly less than those in group B（P 0.05）.Wound effusion were found in 2 cases of group A,and the other incisions healed by first intention.No infection occurred in group B.In group A,13 cases were followed up 12-48 months;in group B,14 cases were followed up 13-46 months.The time of bone graft healing in group A [（7.6 ± 2.1） months] was significantly longer than that in group B [（4.2 ± 1.1） months]（t=2.773,P=0.005）.The kyphosis Cobb angles were significantly improved at 6 months and last follow-up after operation in 2 groups when compared with that before operation（P 0.05）,but no significant difference was found between 2 groups at different time after operation（P 0.05）.There was no significant difference in JOA score at 6 months after operation between group A（14.1 ± 2.6） and group B（14.3 ± 2.4）（t=1.655,P=0.162）.The improvement rate for neural function were 83.7% in group A and 87.8% in group B,showing no significant difference（χ2=3.150,P=0.071）.There was no loosening of internal fixation and recurrence of tuberculosis in 2 groups during follow-up.Five cases had chronic pain at iliac donor sites in group B.According to Bridwell et al.evaluation standard,the bone fusion was satisfactory in 11 cases（84.6%） and unsatisfactory in 2 cases（15.4%） in group A,and was satisfactory for all in 14 cases（100%） in group B.The satisfactory rate of bone fusion showed no significant difference between 2 groups（χ2=2.680,P=0.115）.Conclusion Allogeneic bone grafting has a good clinical result for spinal fusion in cervical tuberculosis surgery,which can treat tuberculosis bone defect effectively.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第11期1290-1293,共4页
Chinese Journal of Reparative and Reconstructive Surgery
基金
宁夏自然科学基金资助项目(NZ10117)~~
关键词
颈椎结核
自体骨移植
同种异体骨移植
脊柱融合
Cervical tuberculosis Autologous bone graft Allogeneic bone graft Spinal fusion
