中国修复重建外科杂志

中国修复重建外科杂志

结构性与非结构性植骨融合治疗单节段胸椎结核的近期疗效

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目的比较一期后路病灶清除非结构性与结构性植骨治疗单节段胸椎结核的近期疗效。方法回顾性分析 2011 年 6 月—2015 年 8 月接受一期后路病灶清除、植骨融合内固定治疗的 61 例患者临床资料,其中采用结构性植骨 26 例(A 组)、非结构性植骨 35 例(B 组)。两组患者性别、年龄、病程、合并症、病变节段、合并椎旁脓肿者以及术前美国脊柱损伤协会(ASIA)分级、C 反应蛋白(C reactive protein,CRP)、疼痛视觉模拟评分(VAS)、病变节段 Cobb 角等比较,差异均无统计学意义(P>0.05);但 B 组术前红细胞沉降率(erythrocyte sedimentation rate,ESR)明显低于 A 组(t=3.128,P=0.003)。记录并比较两组手术时间、术中出血量、住院时间、VAS 评分、ESR、CRP、ASIA 分级、并发症、病变节段 Cobb 角及其矫正率、丢失率以及植骨融合时间。结果B 组手术时间、术中出血量显著少于 A 组,但患者住院时间长于 A 组,差异均有统计学意义(P<0.05)。A 组随访时间为(36.3±10.0)个月,明显长于 B 组的(18.4±4.2)个月(t=10.722,P=0.000)。末次随访时,两组患者 VAS 评分、ESR 及 CRP 均较术前明显改善(P<0.05);B 组 CRP 显著高于 A 组(t=–2.947,P=0.005),ESR 及 VAS 评分比较差异无统计学意义(P>0.05)。末次随访时,两组患者 ASIA 分级均较术前明显改善,组间比较差异无统计学意义(Z=–1.104,P=0.270)。A、B 组术后分别有 9、10 例发生并发症,差异无统计学意义(χ2=0.254,P=0.614)。术后 3 d 时 B 组 Cobb 角明显大于 A 组(t=–2.861,P=0.006);末次随访时两组 Cobb 角差异无统计学意义(t=–1.212,P=0.230)。术后 A 组 Cobb 角矫正率及丢失率均大于 B 组,其中 Cobb 角丢失率比较差异有统计学意义(t=2.261,P=0.031)。两组植骨均融合,B 组植骨融合时间明显短于 A 组,差异有统计学意义(t=4.824,P=0.000)。结论非结构性植骨与结构性植骨治疗单节段胸椎结核均能取得良好临床疗效,但前者具有手术创伤小、植骨融合时间短等优势。

ObjectiveTo compare the short-term effectiveness of one-stage posterior debridement with non-structural bone graft and structural bone graft in the treatment of single segment thoracic tuberculosis.MethodsThe data of 61 patients with single segment thoracic tuberculosis, who were treated by one-stage posterior debridement, bone graft fusion, and internal fixation between June 2011 and August 2015, was retrospectively analyzed. All of them, 26 cases were treated with structural bone graft (group A) and 35 cases with non-structural bone graft (group B). No significant difference was found between the two groups in gender, age, disease duration, comorbidity, involved segments, paravertebral abscess, and preoperative American Spinal Injury Association (ASIA) grade, C reactive protein (CRP), visual analogue scale (VAS) score, and Cobb angle of involved segments (P>0.05). But the preoperative erythrocyte sedimentation rate (ESR) in group B was significantly lower than that in group A (t=3.128, P=0.003). The operation time, intraoperative blood loss, hospitalization stay, VAS score, ESR, CRP, ASIA grade, postoperative complications, Cobb angle of involved segments and its correction rate and loss rate, and bone fusion time were recorded and compared between the two groups.ResultsCompared with group A, group B had shorter operation time, less intraoperative blood loss, and longer hospitalization stay, showing significant differences (P<0.05). The follow-up time of group A was (36.3±10.0) months, which was significantly longer than that of group B [(18.4±4.2) months] (t=10.722, P=0.000). At last follow-up, the VAS score, ESR, and CRP in the two groups all significantly improved when compared with those before operation (P<0.05); the CRP of group B was significantly higher than that of group A (t=–2.947, P=0.005); but there was no significant difference in ESR and VAS score between the two groups (P>0.05). At last follow-up, the ASIA grade of the two groups significantly improved when compared with those before operation, and there was no significant difference between the two groups (Z=–1.104, P=0.270). There were 9 cases and 10 cases of complications in groups A and B, respectively, and there was no significant difference (χ2=0.254, P=0.614). The Cobb angle in group B was significantly higher than that in group A at 3 days after operation (t=–2.861, P=0.006), but there was no significant difference in Cobb angle between the two groups at last follow-up (t=–1.212, P=0.230). The postoperative correction rate and loss rate of Cobb angle in group A were higher than those in group B, and there was a significant difference in the loss rate between the two groups (t=2.261, P=0.031). All patients got bone graft fusion and the bone fusion time of group B was significantly shorter than that of group A (t=4.824, P=0.000).ConclusionNon-structural and structural bone graft can both achieve good effectiveness in the treatment of single segment thoracic tuberculosis, but the former has the advantages of less surgical trauma and shorter fusion time.

关键词: 脊柱结核; 后路清创; 内固定; 结构性植骨; 非结构性植骨

Key words: Spinal tuberculosis; posterior debridement; internal fixation; structural bone graft; non-structural bone graft

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