新型羟基磷灰石骨水泥复合抗结核药物和钛网内固定治疗脊柱结核的临床应用

Study on clinical treatment of patients with spinal tuberculosis by using new hydroxyapatite bone cement composite antirib drugs and titanium mesh internal fixation

目的探讨新型羟基磷灰石骨水泥复合抗结核药物和钛网内固定治疗脊柱结核在临床中的应用价值。方法2011年1月至2014年1月吉林省结核病医院收治的脊柱结核患者中接受了新型羟基磷灰石骨水泥复合抗结核药物和钛网内固定治疗并完成随访的患者共50例。其中男23例，女27例；结核病变位于胸椎28例，腰椎22例，术前神经功能分级按美国脊柱损伤协会（ASIA）神经功能分级，其中A级1例，B级1例，C级6例，D级9例，E级33例。术前抗结核治疗2周，治疗方案为3HRZE／9-15HRE。患者术后第2周及出院后每3个月进行影像学检查，观察患者临床症状、椎间融合情况、脊柱畸形程度、ASIA神经功能分级，分析统计患者治愈情况。结果50例患者随访时间12-36个月，平均随访（20±8）个月；术后无死亡，无严重脊髓神经、大血管及重要脏器损伤，无并发症出现。病椎疼痛症状均消失、椎间融合优良率（I级＋Ⅱ级）为94．0％（47／50），后凸畸形平均即时矫正（20．0±0．7）°，末次随访平均丢失（1．2±0．3）°，内固定取出后平均丢失（0．5±0．2）°，术后ASIA分级E级50例。本组患者均于手术后1～2周内离床下地行走。总治愈率为100．0％（50／50）。结论新型羟基磷灰石骨水泥复合抗结核药物和钛网内固定治疗脊柱结核临床疗效肯定、术后恢复快，是治疗脊柱结核的有效方法。

Objective To investigate the clinical application value of a new type of hydroxyapatite bone cement composite anti tuberculosis （TB） drugs and titanium mesh internal fixation for treatment of patients with spinal TB. Methods Fifty patients with spinal TB who were treated by using the new hydroxyapatite bone cement composite anti-TB drugs and titanium mesh internal fixation at Jilin Provincial TB Hospital from January 2011 to January 2014 were enrolled in our study. Among those patients, 23 cases were male and 27 cases were female; the tuberculous lesions were located in the thoracic spine in 28 cases and lumbar spine in 22 cases; according to the USA Spinal Injury Association （ASIA） Classification, preoperative neurological function was Grade A in 1 patient, Grade B in 1 patient, Grade C in 6 patients, Grade D in 9 patients and Grade E in 33 patients. Before surgical operation, all those patients received anti-TB chemotherapy with the treatment regimen 3HRZE/9-15HRE for 2 weeks; the postoperative evaluations were done at the second week after patients received operations and every three months after patients were discharged from the hospital, and the evaluation was based on imaging examination results, clinical symptoms, intervertebral fusion, spinal deformity degree and neurological classification, etc. Results All patients were followed up for mean （20±8） months （12--36 months）. There were no postoperative deaths, no serious da- mages of spinal nerves, large blood vessels and important organs, no complications. Vertebral pain disappeared in all patients and the excellent and good rate of intervertebral fusion （Level I ＋Level Ⅱ ） was 94. 0%（47/50）, kyphosis instant correction was a mean （20±0.7） degrees and the average loss was （1.2±0.3） degrees in the last follow-up while the average loss was （0.5±0. 2） degrees after internal fixation removal. The ASIA Classification was Grade E in all 50 patients after operations. All patients could walk in 1--2 weeks after operations. In total, the cure rate was 100.0% （50/50）. Conclusion The new hydroxyapatite bone cement composite anti TB drugs and titanium mesh internal fixation has been confirmed by our study to be an effective method for treatment of patients with spinal TB and make Spinal fusion