两种植骨方式在胸腰椎结核手术中的应用

The Application of Two Kinds Bone Grafting Ways in Thoracolum Tuberculosis Spinal Tuberculosis Surgery

目的：比较不同植骨方式治疗胸腰椎结核的手术效果,探讨颗粒自体骨与块状自体骨两种植骨方式在治疗胸腰椎结核的临床疗效.方法：2008年1月至2010年12月期间在我院手术治疗的胸腰椎结核患者132例,其中采用块状自体骨进行骨移植的患者60例,采用颗粒状自体骨进行骨移植的患者72例,随机从两种植骨方式中各抽取20例患者进行回顾性分析,对两组患者术中出血量、住院时间、术后神经功能改善情况、植骨融合情况、后凸畸形矫正状况进行对比.结果：所有患者均一期愈合,无全身并发症,两组患者随访12～36个月,平均18个月,影像学提示内固定位置良好,无松动及断裂,结核病灶无复发.块状骨组术后6个月随访植骨融合率15％（3/20）术后9个月融合率45％（9/20）,术后12个月融合率95％（19/20）.颗粒骨组术后6个月随访植骨融合率45％（9/20）术后9个月融合率80％（16/20）,术后12个月融合率100％.块状骨组术前Cobb角为29.8°±5.0°,术后Cobb角为14.7°±2.5°,末次随访Cobb角为16.0°±2.9°.颗粒骨组术前Cobb角为30.9°±7.6°,术后Cobb角为15.6°±3.8°,末次随访Cobb角为16.7°±3.8°,两组病人术后cobb角较术前有明显矫正,末次随访无明显丢失,两组比较无显著性差异（P＞0.05）.颗粒骨组术中出血量明显少于块状骨组,两组比较有统计学意义（P＜0.05）.住院时间两组比较无显著性差异（P＞0.05）.结论：颗粒状自体骨与块状自体骨相比在胸腰椎结核手术中植入方便,出血量少,植骨融合时间短,融合率高,是胸腰椎结核植骨的理想选择.

Objective： To explore the clinical effect of the granulated autogenous bone and bulk autogenous bone grafting treatme- nts of the thoracolumbar spinal tuberculosis. Methods： 132 cases of spinal tuberculosis patients were surgical treated in our hospital from January 2008 to December 2010. Bulk autogenous bone graft was 60 cases and granulated autogenous bone was 72. Twenty cases were randomly selected from each of the two grafting groups and were retrospectively analyzed of its blood loss, hospital stay, postoperative nerve function improve status, fusion and kyphosis correction conditions. Results： All patients healed without systemic complications; two groups of patients were followed up for 12 to 36 months with an average of 18 months; imaging examinations showed the internal fixations having no loosening and fracture and the tuberculosis lesions were no relapsed. The bulk autogenous bone fusion rate was 15% （3/20） in three months; 45% （9/20） in 6 months and 95% （19/20） in 12 months. The granulated autogenous bone group fusion was rate of 45%（9/20） in 3 months, 80% （16/20） in 6 months and 100% in 12 months. The bulk autogenous bone group preoperative Cobb angle was 29.8° ± 5.0°, the postoperative Cobb angle was 14.7° ± 2.5°and the last followed-up Cobb angle was 16.0°± 2.9°. The granulated autogenous bone preoperative Cobb angle was 30.9 ± 7.6°, the postoperative Cobb angle was 15.6° ± 3.8° and the final follow-up Cobb angle was 16.7°± 3.8°. The two groups had an obvious success in correcting Cobb angle after surgical treatment with having no significant difference （P〉 0.05） in two groups. The granulated autogenous bone group blood loss was significantly less than the bulk autogenous bone with statistically significant （P 〈0.05）. The hospital stay period showed no significant difference （P〉 0.05）. Conclusion： Granulated autogenous bone was much better than bulk autogenous bone grafting in the thoracolumbar spinal tuberculosis surgery treatment with convenient operating, less bleeding, and shorter fusion time, high fusion rate.