不同结构性植骨材料在胸腰椎结核治疗中疗效的回顾性对比研究
发布时间：2019-07-01 08:37
【摘要】：背景:近年来,骨关节结核的发病率呈上升趋势,其中脊柱结核占全身骨关节结核的50%左右,而胸腰椎结核是脊柱结核的好发部位。胸腰椎结核可造成患者严重畸形、神经功能障碍,甚至全瘫,严重影响着人们的健康。目前多数较轻微的结核可以通过保守治疗治愈,但是对于严重结核,在使用抗结核药物化疗的的同时仍需要手术治疗来促进结核愈合,重建脊柱稳定性,减少伤残,避免和治疗各种并发症,提高脊柱结核患者的生活质量。目的:本课题旨在通过回顾性研究比较不同植骨方式治疗单节段及跨节段胸腰椎结核的手术效果,探讨钛网、自体髂骨块、同种异体骨及椎间融合器四种植骨方式在治疗胸腰椎结核中的临床疗效。为临床医生在脊柱结核患者彻底病灶清除后选择何种植骨技术和结构性植骨材料提供临床依据。研究对象与方法:1.回顾性分析我院2005年1月至2013年5月收治的单节段胸腰椎结核患者。研究对象:在抗结核治疗基础上采用前路或后路彻底病灶清除、植骨融合内固定术治疗且有24个月以上随访记录的患者。分组:钛网组(A组)29例;自体髂骨块组(B组)32例;同种异体骨组(C组)25例;椎间融合器组(D组)26例。临床疗效评价指标:①美国脊髓损伤协会(ASIA)评分分级;②术前、术后后凸畸形角度(Cobb’s角)及末次随访时丢失的Cobb’s角;③植骨融合率,植骨融合情况,采用Bridwell评价标准;④手术的时间;⑤术中出血量;⑥住院的时间;⑦术后引流量;⑧并发症。随访方式:通过门诊、电话及信件等方式进行随访。比较方式:组内术前与术后随访时间段对比,组间同一时间段对比。2.回顾性分析我院2005年1月至2013年5月收治的跨节段胸腰椎结核患者。研究对象:在抗结核治疗基础上采用前路或后路彻底病灶清除、植骨融合内固定术治疗且有24个月以上随访记录的患者。分组:钛网组(a组)30例;自体髂骨块组(b组)27例;同种异体骨组(c组)25例。临床疗效评价指标:①美国脊髓损伤协会(asia)评分分级;②术前、术后后凸畸形角度(cobb’s角)及末次随访时丢失的cobb’s角;③植骨融合率,植骨融合情况,采用bridwell评价标准;④手术的时间;⑤术中出血量;⑥住院时间;⑦术后的引流量;⑧并发症。随访方式:通过门诊、电话及信件等方式进行随访。比较方式:组内术前与术后随访时间段对比,组间同一时间段对比。结果:1、纳入研究单节段病例有112例,随访24~67个月,平均43.6个月。四组结核患者在手术后的神经功能与术前相比均有改善,但各组之间比较没有显著性差异(p0.05)。四组患者手术后的后凸角度均有明显改善(p0.05),四组之间比较没有显著性差异(p0.05),在末次随访时各组患者cobb角丢失度比较差异无显著性(p0.05)。a、b组12月植骨融合率比较差异无显著性(p0.05),a、c、d组比较差异具有显著性(p0.05),a组高于c、d组。b组患者的手术时间、术中出血量均多于a、c、d组,具有显著性差异(p0.05);a、c、d组手术时间、术中出血量比较,差异无显著性(p0.05);四组患者术后引流量及住院时间比较差异无显著性(p0.05)。四组间比较并发症率无统计学差异(p0.05)。末次随访时各组均融合,无植骨材料及内固定的松动或移位。2、纳入研究跨节段病例有82例,随访24~72个月,平均45.5个月。三组结核患者术后的神经功能较手术前均有改善,但组间没有显著性差异(p0.05)。三组结核患者术后的后凸角度均有明显改善(p0.05),三组之间比较没有显著性差异(p0.05),患者的末次随访时各组患者cobb角丢失度比较差异无显著性(p0.05)。a、b组植骨融合率比较差异无显著性(p0.05),a、c组比较差异具有显著性(p0.05),a组高于c组。b组结核患者手术时间、术中出血量均多于a、c组,差异具有显著性(p0.05);a、c组手术时间、术中出血量比较,差异无显著性(p0.05);三组患者术后引流量及住院时间比较差异无显著性(p0.05)。三组间比较并发症率无统计学差异(p0.05)。末次随访时各组均融合,无植骨材料及内固定的松动或移位。结论:1、本研究中不同结构性植骨材料在单节段、跨节段胸腰椎结核治疗中均可获得良好的临床疗效。2、单节段胸腰椎结核治疗中,钛网植骨较自体髂骨块植骨,植骨融合率相当,但可以有效缩短手术时间、减少术中出血量;钛网植骨较同种异体骨植骨及Cage植骨,手术时间、术中出血量没有显著差异,但植骨融合率更高。3、跨节段胸腰椎结核治疗中,钛网植骨较自体髂骨块植骨,植骨融合率相当,但可以有效缩短手术时间、减少术中出血量;钛网植骨较同种异体骨植骨,手术时间、术中出血量没有显著差异,但植骨融合率更高。4、钛网是胸腰椎结核植骨的理想材料,钛网植骨是治疗胸腰椎结核的一种安全有效的方法。
[Abstract]:BACKGROUND: In recent years, the incidence of bone and joint tuberculosis is on the rise, among which, the spinal tuberculosis accounts for about 50% of the total body and bone joint tuberculosis, and the thoracic and lumbar tuberculosis is a good part of the spinal tuberculosis. The thoracic and lumbar tuberculosis can cause serious deformity, neurological disorder and even total paralysis of the patient, which seriously affects people's health. At present, most of the minor tuberculosis can be cured by conservative treatment, but for severe tuberculosis, the operation treatment is required to promote the healing of the tuberculosis, the reconstruction of the stability of the spine, the reduction of the disability, the avoidance and the treatment of various complications, And the quality of life of patients with spinal tuberculosis is improved. Objective: To study the effect of different bone grafting methods on the treatment of thoracolumbar spinal tuberculosis with different bone graft methods, and to explore the clinical effect of titanium mesh, autograft bone mass, allogenic bone and interspinous process in the treatment of thoracic and lumbar tuberculosis. To provide a clinical basis for the selection of bone and structural bone graft materials for clinical doctors after thorough debridement of the patients with spinal tuberculosis. Research object and method:1. The patients of thoracolumbar tuberculosis from January 2005 to May 2013 were analyzed retrospectively. Study object: The patients who were treated with anterior or posterior complete lesion removal, bone graft fusion and internal fixation with 24-month follow-up were used on the basis of anti-tuberculosis treatment. Group:29 cases of titanium net group (group A),32 cases of autograft group (group B),25 cases of allogenic bone group (group C),26 cases of intervertebral fusion group (D group). The evaluation index of clinical curative effect: the classification of the American Spinal Cord Injury Association (AIA); the angle of the post-operative kyphosis (Cobb's angle) and the lost Cobb's angle at the last follow-up; the fusion rate of the implant and the fusion of the bone graft; the Bridwell evaluation standard; the time of the orthopedic operation; Keywords Intraoperative hemorrhagic volume; hospitalization time; post-operative drainage; complications. Follow-up: follow-up through out-patient, telephone and letter. Comparison method: compared with the follow-up period before and after the intra-operative procedure, the same time period was compared between the groups. A retrospective analysis of patients with transthoracic and lumbar tuberculosis from January 2005 to May 2013 was analyzed retrospectively. Study object: The patients who were treated with anterior or posterior complete lesion removal, bone graft fusion and internal fixation with 24-month follow-up were used on the basis of anti-tuberculosis treatment. Group:30 cases of titanium net group (group a),27 cases of autogenous bone block group (b group),25 cases of allogenic bone group (c group). The evaluation index of clinical curative effect: the score of the spinal cord injury association (asia) in the United States; the angle of the post-operative kyphosis (the angle of the cob's) and the loss of the cob's angle at the last follow-up; the fusion rate of the implant and the fusion of the bone graft, using the Bridwell evaluation standard; the time of the orthopedic operation; Keywords Intraoperative hemorrhagic volume; hospitalization time; post-operative drainage; complications. Follow-up: follow-up through out-patient, telephone and letter. Comparison method: compared with the follow-up period before and after the intra-operative procedure, the same time period was compared between the groups. Results:1.112 cases were included in the single section of the study, followed up for 24 to 67 months, with an average of 43.6 months. The neurological function of four groups was improved after operation, but there was no significant difference between the groups (p0.05). There was no significant difference between the four groups (p0.05), and there was no significant difference between the four groups (p0.05). The difference of group d in group d was significant (p0.05), and group a was higher than that of c and d. The operative time of group b and the amount of intraoperative blood loss were more than a, c and d, and there was a significant difference (p0.05), and the operative time of group a, c and d and the amount of intraoperative blood loss were not significant (p0.05). There was no significant difference between the post-operative drainage and the hospital stay in the four groups (p0.05). There was no statistical difference between the four groups (p0.05). At the last follow-up, all groups were fused, and there was no loose or dislodgment of bone graft material and internal fixation. There were 82 cases of cross-section in the study, followed up for 24 to 72 months, with an average of 45.5 months. The neurological function of the three groups was improved after operation, but there was no significant difference between the groups (p0.05). There was no significant difference between the three groups (p0.05), and there was no significant difference between the three groups (p0.05). There was significant difference in group c (p0.05), and group a was higher than that in group c. There was no significant difference (p0.05) between the operation time of the group B and the amount of blood loss during the operation, and the difference between the operation time of the group a and c and the amount of blood loss during the operation was not significant (p0.05), and there was no significant difference between the postoperative drainage and the hospitalization time in the three groups (p0.05). There was no statistical difference between the three groups (p0.05). All groups were fused at the last follow-up, and there was no loosening or displacement of the bone graft material and the internal fixation. Conclusion:1. Different structural bone graft materials in this study can achieve good clinical curative effect in the treatment of single-section and cross-section thoracolumbar tuberculosis. But the operation time can be effectively shortened, the intraoperative blood loss is reduced, the titanium mesh bone grafting is more than the allograft bone grafting and the Cage bone grafting, the operation time and the intraoperative blood loss are not significantly different, but the fusion rate of the bone grafting is higher. The fusion rate of the bone graft is equivalent, but the operation time can be effectively shortened, the intraoperative blood loss is reduced, the titanium mesh bone graft is more than the allograft bone graft, the operation time and the intraoperative blood loss are not significantly different, but the fusion rate of the bone grafting is higher. Titanium mesh bone graft is a safe and effective method for treating thoracic and lumbar tuberculosis.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
[Abstract]:BACKGROUND: In recent years, the incidence of bone and joint tuberculosis is on the rise, among which, the spinal tuberculosis accounts for about 50% of the total body and bone joint tuberculosis, and the thoracic and lumbar tuberculosis is a good part of the spinal tuberculosis. The thoracic and lumbar tuberculosis can cause serious deformity, neurological disorder and even total paralysis of the patient, which seriously affects people's health. At present, most of the minor tuberculosis can be cured by conservative treatment, but for severe tuberculosis, the operation treatment is required to promote the healing of the tuberculosis, the reconstruction of the stability of the spine, the reduction of the disability, the avoidance and the treatment of various complications, And the quality of life of patients with spinal tuberculosis is improved. Objective: To study the effect of different bone grafting methods on the treatment of thoracolumbar spinal tuberculosis with different bone graft methods, and to explore the clinical effect of titanium mesh, autograft bone mass, allogenic bone and interspinous process in the treatment of thoracic and lumbar tuberculosis. To provide a clinical basis for the selection of bone and structural bone graft materials for clinical doctors after thorough debridement of the patients with spinal tuberculosis. Research object and method:1. The patients of thoracolumbar tuberculosis from January 2005 to May 2013 were analyzed retrospectively. Study object: The patients who were treated with anterior or posterior complete lesion removal, bone graft fusion and internal fixation with 24-month follow-up were used on the basis of anti-tuberculosis treatment. Group:29 cases of titanium net group (group A),32 cases of autograft group (group B),25 cases of allogenic bone group (group C),26 cases of intervertebral fusion group (D group). The evaluation index of clinical curative effect: the classification of the American Spinal Cord Injury Association (AIA); the angle of the post-operative kyphosis (Cobb's angle) and the lost Cobb's angle at the last follow-up; the fusion rate of the implant and the fusion of the bone graft; the Bridwell evaluation standard; the time of the orthopedic operation; Keywords Intraoperative hemorrhagic volume; hospitalization time; post-operative drainage; complications. Follow-up: follow-up through out-patient, telephone and letter. Comparison method: compared with the follow-up period before and after the intra-operative procedure, the same time period was compared between the groups. A retrospective analysis of patients with transthoracic and lumbar tuberculosis from January 2005 to May 2013 was analyzed retrospectively. Study object: The patients who were treated with anterior or posterior complete lesion removal, bone graft fusion and internal fixation with 24-month follow-up were used on the basis of anti-tuberculosis treatment. Group:30 cases of titanium net group (group a),27 cases of autogenous bone block group (b group),25 cases of allogenic bone group (c group). The evaluation index of clinical curative effect: the score of the spinal cord injury association (asia) in the United States; the angle of the post-operative kyphosis (the angle of the cob's) and the loss of the cob's angle at the last follow-up; the fusion rate of the implant and the fusion of the bone graft, using the Bridwell evaluation standard; the time of the orthopedic operation; Keywords Intraoperative hemorrhagic volume; hospitalization time; post-operative drainage; complications. Follow-up: follow-up through out-patient, telephone and letter. Comparison method: compared with the follow-up period before and after the intra-operative procedure, the same time period was compared between the groups. Results:1.112 cases were included in the single section of the study, followed up for 24 to 67 months, with an average of 43.6 months. The neurological function of four groups was improved after operation, but there was no significant difference between the groups (p0.05). There was no significant difference between the four groups (p0.05), and there was no significant difference between the four groups (p0.05). The difference of group d in group d was significant (p0.05), and group a was higher than that of c and d. The operative time of group b and the amount of intraoperative blood loss were more than a, c and d, and there was a significant difference (p0.05), and the operative time of group a, c and d and the amount of intraoperative blood loss were not significant (p0.05). There was no significant difference between the post-operative drainage and the hospital stay in the four groups (p0.05). There was no statistical difference between the four groups (p0.05). At the last follow-up, all groups were fused, and there was no loose or dislodgment of bone graft material and internal fixation. There were 82 cases of cross-section in the study, followed up for 24 to 72 months, with an average of 45.5 months. The neurological function of the three groups was improved after operation, but there was no significant difference between the groups (p0.05). There was no significant difference between the three groups (p0.05), and there was no significant difference between the three groups (p0.05). There was significant difference in group c (p0.05), and group a was higher than that in group c. There was no significant difference (p0.05) between the operation time of the group B and the amount of blood loss during the operation, and the difference between the operation time of the group a and c and the amount of blood loss during the operation was not significant (p0.05), and there was no significant difference between the postoperative drainage and the hospitalization time in the three groups (p0.05). There was no statistical difference between the three groups (p0.05). All groups were fused at the last follow-up, and there was no loosening or displacement of the bone graft material and the internal fixation. Conclusion:1. Different structural bone graft materials in this study can achieve good clinical curative effect in the treatment of single-section and cross-section thoracolumbar tuberculosis. But the operation time can be effectively shortened, the intraoperative blood loss is reduced, the titanium mesh bone grafting is more than the allograft bone grafting and the Cage bone grafting, the operation time and the intraoperative blood loss are not significantly different, but the fusion rate of the bone grafting is higher. The fusion rate of the bone graft is equivalent, but the operation time can be effectively shortened, the intraoperative blood loss is reduced, the titanium mesh bone graft is more than the allograft bone graft, the operation time and the intraoperative blood loss are not significantly different, but the fusion rate of the bone grafting is higher. Titanium mesh bone graft is a safe and effective method for treating thoracic and lumbar tuberculosis.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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