三种不同植骨方式在胸、腰椎结核手术治疗中的观察

Three different bony graft methods in thoracic and lumbar spinal tuberculosis surgery

中文关键词:  脊柱  结核  脊柱融合术  植骨

英文关键词:Tuberculosis  Spinal  Spinal fusion  Bone graft

中文摘要:

  【摘要】 目的：对比观察块状植骨、颗粒植骨和钛网植骨三种不同植骨方式在后路胸腰椎结核手术中的临床应用效果。方法：选取我院93例胸、腰椎结核患者，分为三组，彻底结核病灶清除后，分别采用块状植骨（32例）、颗粒植骨（35例）、钛网植骨（26例）三种不同植骨方式，对三组术中植骨所需时间，术中出血量，术后后凸畸形角纠正状况，末次随访后凸畸形角丢失状况，植骨融合时间进行对比。结果：患者均得到12～36个月随访，植骨所需手术时间A组为23.4±4.3min，B组为5.2±2.4min，C组为25.6±3.6min，B组植骨所需时间明显短于A组、C组（P<0.05），A组、C组比较差异无统计意义（P＞0.05）；术中出血量A组为553±53ml，B组为352±48ml，C组为564±47ml，B组明显少于A组、C组（P<0.05），A组、C组比较差异无统计意义（P＞0.05）；术前Cobb角A组为36.5°±5.9°，B组为36.2°±4.7°，C组为36.8°±5.1°，三组差异无统计学意义（P＞0.05），术后Cobb角A、B、C三组分别为15.3°±3.6°、15.6°±3.1°及15.1°±2.9°，三组间差异无统计学意义（P＞0.05）；末次随访时Cobb角A组为16.9°±3.6°，平均丢失1.6°，B组为17.5°±3.1°，平均丢失1.9°，C组为16.8°±2.9°，平均丢失1.7°，三组差异无统计学意义（P＞0.05）；植骨融合时间A组为5.9±0.4个月，B组为4.1±0.3个月，C组为6.2±0.5个月，B组明显短于A组、C组（P<0.05），A组、C组比较差异无统计意义（P＞0.05）。结论：颗粒骨植骨较传统块状植骨和钛网植骨植入方便易行，植入时间短，出血量少，植骨融合时间短，是后路胸椎结核病灶清除术后理想的植骨方式。

英文摘要:

  【Abstract】 Objective: To evaluate the clinical outcomes of structure bone graft, micromorselized bone graft and titanium mesh bone graft for thoracic and lumber tuberculosis. Methods: 93 patients with lumbar and thoracic tuberculosis were divided in three groups, three different bone graft methods were used in three groups respectively after debridement(group A: structure bone graft, n=32; group B: micromorselized bone graft, n=35; group C: ttitanium mesh bone graft, n=26). The operation time, blood loss, correction and loss of correction of kyphosis, the fusion time were evaluated and compared among three groups. Results: All patients were followed up for 12-36 months. The operation time in group A, B and C was 23.4±4.3min, 5.2±2.4min, 25.6±3.6min respectively, with group B less than the other two groups(P<0.05), but no significant difference existed between group A and C(P＞0.05). The blood loss in group A, B and C was 553±53ml, 352±48ml, and 564±47ml respectively, with group B less than the other two groups(P<0.05), but no significant difference existed between group A and C(P＞0.05). The Cobb angle of kyphosis in group A, B and C before operation was 36.5°±5.9°, 36.2°±4.7° and 36.8°±5.1° respectively, no significant difference existed in three groups(P＞0.05). The Cobb angle of kyphosis in three groups after operation was 15.3°±3.6°, 15.6°±3.1° and 15.1°±2.9 respectively, no significant difference existed in three groups(P＞0.05). The Cobb angle of kyphosis at final follow-up for group A, B and C was 16.9°±3.6° with the loss of correction of 1.6°, 17.5°±3.1° with the loss of 1.9°, 16.8°±2.9° with the loss of 1.7°, which showed no significant difference in three groups(P＞0.05). The fusion time in group A, B, and C was 5.9±0.4 months, 4.1±0.3 months and 6.2±0.5 months respectively, with group B less than the other two groups(P<0.05), but no significant difference existed between group A and C(P＞0.05). Conclusions: The micromorselized bone graft is reliable for thoracic and lumbar tuberculosis.