摘要
目的探讨同种异体髂骨联合钛笼治疗脊柱结核的疗效和临床应用价值。方法回顾性分析2012年6月至2014年8月河北省胸科医院收治的139例脊柱结核患者的术前、术后资料。男72例，女67例；年龄15～72岁，平均（47．6±16．7）岁；其中颈椎6例，胸椎15例，胸腰段23例，腰椎77例，腰骶段18例；脊柱后凸畸形116例，脊柱后凸角度（Cobb角）（12．1～46．3）°，术前给予抗结核治疗2～4周，术后定期复查植骨融合情况、Cobb角的变化、血红细胞沉降率（ESR）、神经功能恢复情况，对疗效进行评价。采用SPSS17．0软件进行配对f检验，评价术后2周、末次随访时Cobb角和ESR与术前的差异，P〈0．05为差异有统计学意义。结果随访13~30个月，平均（18．5±3．4）个月。134例椎间植骨块融合时间为3～10个月，平均（7．5±3．6）个月，按照骨融合标准，其中优125例（93．3％），良9例（6．7％）。4例保留稳定性硬化骨，椎体植骨融合时间10～18个月。其中优2例，良1例，可1例。1例植骨块术后2个月出现塌陷。总体植骨融合优良率99．3Voo（138／139）。116例患者Cobb角术后2周为（13．85±4．27）°，末次随访为（14．72±5．63）°，分别与术前（22．36±6．75）°比较，差异均有统计学意义（t值分别为10．904、8．592，P值均〈0．05）。139例患者ESR术后2周为（28．42±9．37）mm／1h，末次随访为（8．35±3．48）mm／1h，分别与术前（37．63±15．78）mm／1h比较，差异均有统计学意义（￡值分别为4．255、12．792，P值均〈0．05）。神经功能恢复情况：8例术前合并截瘫患者，Frankel分级B级2例恢复至D级；C级3例中2例恢复至E级，1例恢复至D级；3例D级全部恢复至E级。结论同种异体髂骨联合钛笼治疗在脊柱结核椎间植骨中能重建脊柱稳定性、形成骨性融合，达到治愈结核病的效果，值得临床推广应用。
Objective To assess the efficacy and nium mesh cage in the treatment of spinal tuberculosis. clinical application of allograft iliac bone combined with tita- Methods The pre- and post-operation clinical data were collected from 139 patients with spinal tuberculosis admitted in Hebei Chest Hospital from Jun. 2012 to Aug. 2014. There were 72 males and 67 females, average age （47.6i 16.7） years old, including 6 cases with cervical tuberculo- sis, 15 cases with thoracic spine tuberculosis, 23 cases with thoracolumbar tuberculosis, 77 cases with lumbar tu- berculosis and 18 cases with lumbosacral segment tuberculosis. One hundred and sixteen cases were kyphosis de- formity with kyphosis angle （Cobb angle） ranged from 12.1 to 46.3 degree. All patients were received chemothera- py from 2 to 4 weeks before operation, and the following information was collected to evaluate efficacy including the condition of bone graft fusion, Cobb angle, erythrocyte sedimentation rate （ESR）, and the recovery of neurological function at the second week and last follow-up after operation. The measurement data of Cobb angle and ESR were analyzed using paired t test with SPSS software version 17.0. P〈0.05 was considered significant difference statistically. Results The average period of follow-up was （18.5±3.4） months ranged from 13 to 30 months. The average fusion time of intervertebral bone graft was （7.5±3.6） months ranged from 3 to 10 months in 134 cases. One hundred and twenty-five cases belonged to excellent and 9 cases belonged to better according to the standard of bone fusion. The intervertebral bone graft was stable sclerotic bone and the time of bone fusion was from 10 to 18 months in 4 cases including excellent in 2 cases, better and good in each one case. The overall excellent and good rate of bone graft fusion was 99.3% （138/139） except for one case with collapse of bone graft in 2 months after operation. The Cobb angle was （13.85±4. 27） degree at the second week after operation and （14. 72±5.63） degree at the last follow-up in 116 cases. The difference compared with pre〉operative Cobb angle （（ 13.85±4.27） degree） was signifi- cant statistically （t：10. 904 and 8. 592, P〈0.05）. The ESR was （28.42!9.37） mm/1 h at the second week after operation and （8.35±3.48） ram/1 h at the last follow up in 139 cases. The difference compared with pre-operative ESR （（37.63±15.78） mm/1 h） was significant statistically （t：4.225 and 12. 792, P〈0.05）. The recovery of neurological function in 8 cases with paraplegia was as follows： Frankel recovered from grade B to D in 2 cases, from C to E in 2 cases, from C to D in one case and from D to E in 3 cases. Conclusion Allograft iliac bone combined with titanium mesh cage in the treatment of spinal tuberculosis can reconstruct spine stability, format bone fusion and achieve cure effect. It is worthy to be clinical popularization and application.
出处
《中国防痨杂志》
CAS
2016年第5期386-392,共7页
Chinese Journal of Antituberculosis
关键词
脊柱结核
脊柱/外科学
移植
同种异体骨
Spinal tuberculosis
Spine/surgery
Transplantation
Bone allograft
