钛笼植骨融合与髂骨植骨融合联合内固定治疗胸腰椎结核的比较研究

发布时间：2018-03-03 03:17

本文选题：胸腰椎结核　切入点：钛笼植骨　出处：《福建医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:分析比较钛笼填充自体颗粒骨植骨与自体髂骨块植骨在一期后路病灶清除植骨融合内固定治疗胸腰椎结核的临床疗效。方法:回顾性分析2012年6月至2014年9月在福建医科大学附属第一医院脊柱外科行一期后路病灶清除植骨融合内固定治疗的51例胸腰椎结核患者,其中钛笼植骨融合组(A组)25例,髂骨植骨融合组(B组)26例。观察两组的手术时间、出血量、手术前后脊髓神经功能Frankel分级,炎症指标ESR,手术前后局部后凸畸形Cobb角矫正情况、植骨融合时间等,并进行分析比较。结果:所有患者术后病理检查均证实为结核病变,随访时间6-30月,随访期内所有患者均达到骨性融合。A组术后1例患者出现病灶复发,B组无出现结核病灶复发,但有2例出现髂骨取骨区血肿、伤口愈合欠佳。术后无内固定物断裂、假关节形成等并发症,植骨达骨性融合时间A组6-12个月,平均8.00±2.14个月,B组5-12个月,平均6.92±1.85个月,二者差异无统计学意义(P0.05)。在矫正后凸畸形角度上A组平均矫正9.50±8.76°,B组平均矫正6.84±7.94°,末次随访丢失角度A组平均1.68±3.96°,B组平均1.95±3.02°,在改善神经功能、矫正后凸角度及末次随访矫正丢失角度上二者差异无统计学意义(P0.05)。A组平均手术时间202.16±53.20min,B组282.27±65.26min,A组平均住院时间30.44±9.30天,B组为44.35±13.53天,A组显著低于B组,两组在手术时间、住院时间上差异有统计学意义(P0.05),术中出血量A组平均为712.40±419.34ml,B组951.92±799.69ml,二者比较无统计学意义(P0.05)。A组术前血沉平均60.76±20.19mm/h,术后1周血沉平均45.28±17.68mm/h,术后3个月血沉平均29.72±16.97mm/h,B组术前血沉平均53.69±31.69mm/h,术后1周血沉平均37.00±25.52mm/h,术后3个月血沉平均24.54±17.32mm/h,两组在术前、术后1周、术后3月的时间点上ESR差异无统计学意义(P0.05),术后1周、术后3个月ESR较术前有明显改善,差异有统计学意义(P0.05)。结论:(1)胸腰椎结核行一期后路病灶清除后置入填充自体颗粒骨的钛笼进行植骨融合内固定是安全可行的,其临床疗效对比髂骨植骨无明显差异。(2)与髂骨植骨融合相比,一期后路病灶清除钛笼植骨融合内固定术可有效减少手术时间,缩短患者住院时间,同时可避免术后出现髂骨区疼痛、血肿等并发症,而远期随访矫正角度的丢失及融合时间无显著差别。(3)一期后路结核病灶清除应用钛笼植骨融合内固定治疗脊柱结核,术后可有效矫正胸腰椎结核后凸畸形且可获得即刻的稳定性,临床疗效明显,长期疗效有待进一步观察。
[Abstract]:Objective: to compare the clinical efficacy of titanium cage with autologous grafted bone graft and autogenous iliac bone graft in the treatment of thoracolumbar tuberculosis by posterior debridement, bone grafting and internal fixation. Methods: from June 2012 to 2014, a retrospective analysis was made on the treatment of thoracolumbar tuberculosis. In September, 51 patients with thoracolumbar tuberculosis were treated with posterior debridement, bone grafting, fusion and internal fixation in spinal surgery department of the first affiliated Hospital of Fujian Medical University. There were 25 cases in group A and 26 cases in group B in titanium cage bone graft fusion group and iliac bone graft fusion group respectively. The operation time, blood loss, Frankel grade of spinal cord nerve function, inflammation index, Cobb angle correction of local kyphosis before and after operation were observed. Results: all the patients were proved to be tuberculosis by pathological examination after operation, and the follow-up time was 6 to 30 months. During the follow-up period, all the patients achieved bone fusion. One patient in group A had recurrence of foci and no recurrence of tuberculosis in group B, but there were 2 cases of hematoma in iliac bone extraction area, which resulted in poor wound healing and no fracture of internal fixation after operation. The time of bone grafting to bony fusion was 6-12 months (mean 8.00 卤2.14 months) and 5-12 months (mean 6.92 卤1.85 months) in group B. There was no significant difference between the two groups in terms of correction of kyphosis. The average correction of group A was 9.50 卤8.76 掳and that of group B was 6.84 卤7.94 掳, while that of group A at the last follow-up was 1.68 卤3.96 掳and 1.95 卤3.02 掳respectively. There was no significant difference between the correction kyphosis angle and the lost correction angle at the last follow-up. The average operation time of group A was 202.16 卤53.20 min. The average hospitalization time of group A was 30.44 卤9.30 days, the average hospitalization time of group B was 44.35 卤13.53 days, and the mean time of operation in group B was significantly lower than that in group B. There was significant difference in hospitalization time between two groups (P 0.05). The average intraoperative blood loss in group A was 712.40 卤419.34 ml / h, in group B 951.92 卤799.69 ml. There was no significant difference between the two groups. The mean preoperative ESR was 60.76 卤20.19 mm / h in group A, the mean erythrocyte sedimentation rate was 45.28 卤17.68 mm / h at one week after operation, and the mean preoperative ESR in group B was 29.72 卤16.97mm / h at 3 months after operation. The mean ESR was 53.69 卤31.69mm / h, 37.00 卤25.52mm / h at 1 week postoperatively and 24.54 卤17.32mm / h at 3 months postoperatively. There was no significant difference in ESR between 1 week after operation and March after operation (P 0.05). ESR was significantly improved at 1 week and 3 months after operation. The difference was statistically significant (P 0.05). Conclusion it is safe and feasible to implant titanium cage filled with autologous granular bone for fusion fixation of thoracolumbar tuberculosis after one stage posterior debridement. Compared with iliac bone graft fusion, one stage posterior debridement with titanium cage fusion and internal fixation can effectively reduce the operation time and shorten the hospitalization time. Complications such as iliac pain, hematoma and other complications could be avoided after operation. However, there was no significant difference in the loss of correction angle and fusion time in the long term follow-up. There was no significant difference in the removal of posterior tuberculous foci. Titanium cage bone graft fusion and internal fixation were used to treat spinal tuberculosis. Postoperative correction of thoracolumbar tuberculosis kyphosis deformity and immediate stability can be achieved, the clinical efficacy is obvious, the long-term effect needs to be further observed.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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