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段平国, 林思俭, 范荣豪, 等. 后路截骨式病灶清除钛笼植骨融合术治疗胸腰椎结核的疗效分析[J]. 中国临床医学, 2022, 29(6): 976-981. DOI: 10.12025/j.issn.1008-6358.2022.20221383
引用本文: 段平国, 林思俭, 范荣豪, 等. 后路截骨式病灶清除钛笼植骨融合术治疗胸腰椎结核的疗效分析[J]. 中国临床医学, 2022, 29(6): 976-981. DOI: 10.12025/j.issn.1008-6358.2022.20221383
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DUAN Ping-guo, LIN Si-jian, FAN Rong-hao, et al. Analysis of posterior debridement with osteotomy and titanium mesh bone graft fusion in the treatment of thoracolumbar tuberculosis[J]. Chin J Clin Med, 2022, 29(6): 976-981. DOI: 10.12025/j.issn.1008-6358.2022.20221383
Citation: DUAN Ping-guo, LIN Si-jian, FAN Rong-hao, et al. Analysis of posterior debridement with osteotomy and titanium mesh bone graft fusion in the treatment of thoracolumbar tuberculosis[J]. Chin J Clin Med, 2022, 29(6): 976-981. DOI: 10.12025/j.issn.1008-6358.2022.20221383
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后路截骨式病灶清除钛笼植骨融合术治疗胸腰椎结核的疗效分析

Analysis of posterior debridement with osteotomy and titanium mesh bone graft fusion in the treatment of thoracolumbar tuberculosis

    摘要
  • 摘要:
    目的 探讨后路截骨式病灶清除钛笼植骨融合术治疗胸腰椎结核的临床疗效及安全性。
    方法 回顾性分析2014年3月至2018年11月在南昌大学第一附属医院骨科接受手术治疗的96例胸腰椎结核患者的资料，其中29例接受截骨式病灶清除钛笼植骨融合术（截骨组），67例接受刮除式病灶清除植骨融合术（刮除组）。记录两组患者的手术时间、术中出血量、住院时间、术后并发症；术后随访患者的血沉、C反应蛋白、视觉模拟评分（visual analog scale, VAS）、日本骨科协会（Japanese Orthopaedic Association, JOA）评分与Oswestry功能障碍指数（Oswestry disability index, ODI）评分；影像学评估局部Cobb角和植骨融合情况。
    结果 截骨组手术时间为（186.0±39.6）min，较刮除组（207.6±75.8）min缩短（P＝0.043）；截骨组术中出血量为（903.0±88.9）mL，较刮除组（1 094.1±265.1）mL减少（P＝0.028）。两组患者住院时间（9.7±1.3）d vs（10.0±1.1）d和局部Cobb角纠正度（13.1±5.6）° vs（12.6±4.9）°差异无统计学意义。截骨组植骨融合时间平均为（7.7±1.3）个月，较刮除组（8.4±1.8）个月更短（P＝0.047）。两组患者VAS、JOA、ODI评分术后均得到改善，组间差异无统计学意义。截骨组与刮除组分别有2、11例发生术后并发症。截骨组无复发病例，刮除组有5例复发。
    结论 与刮除式病灶清除植骨融合术比较，后路截骨式病灶清除钛笼植骨融合术病灶清除更彻底、术后复发率更低，是治疗胸腰椎结核安全、有效的手术方式。

     

    Abstract:
    Objective To explore the efficacy and safety of posterior debridement with osteotomy and titanium mesh bone graft fusion in the treatment of thoracolumbar tuberculosis.
    Methods From March 2014 to November 2018, 96 patients with thoracolumbar tuberculosis in the First Affiliated Hospital of Nanchang University were retrospectively analyzed. Among 96 patients, 29 patients accepting posterior debridement with osteotomy and titanium mesh bone graft fusion were allocated into group osteotomy (group O), and 67 patients accepting traditional posterior curettage debridement and bone graft fusion were allocated into group curettage (group C). Operation time, intraoperative blood loss, hospitalization time, postoperative complications were recorded. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) scale and Oswestry disability index (ODI) were recorded. The local spinal interbody kyphosis angle (Cobb angle) and spinal bone fusion time were evaluated by the radiological imaging indexes.
    Results Compared with group C, the operative time was shorter in group O (186.0±39.6 min vs 207.6±75.8 min, P＝0.043), and blood loss was less in group O (903.0±88.9 mL vs 1 094.1±265.1 mL, P＝0.028). No significant difference was found in hospitalization time (9.7±1.3 d vs 10.0±1.1 d) and correction degree of Cobb angle (13.1±5.6 ° vs 12.6±4.9 °) between the two groups. Time of interbody fusion was shorter in group O than group C (7.7±1.3 month vs 8.4±1.8 month, P＝0.047). No significant difference in VAS, JOA and ODI scores was found between the two groups. There were 2 and 11 patients with postoperative complications in group O and group C, respectively. No tuberculosis recurrence was found in group O, but there were 5 patients suffered from the spinal tuberculosis recurrence in group C.
    Conclusions Compared to the traditional curettage debridement, the debridement with osteotomy and titanium mesh bone graft fusion is a more effective and safe surgical strategy for treating the patients with thoracolumbar tuberculosis.

     

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