一期前路病灶清除同种异体骨移植病灶区内固定术治疗脊柱结核的随访观察

Spinal tuberculosis after one-stage anterior or lateral anterior allografting and internal fixation: a follow-up study

目的探讨经前路一期病灶清除椎间植骨融合内固定手术对脊柱结核患者的治疗效果,评价同种异体髂骨块的安全性和有效性。方法回顾性分析2008年1月至2012年12月在我科诊断为脊柱结核患者病例资料,严格按手术指征筛选出适合采用经前路一期病灶清除椎间植骨融合内固定手术的患者共60例,植骨材料选择同种异体髂骨块。术后继续标准化抗结核化疗方案12~18个月,同时佩戴支具3~6个月;随访9~36（22.80±7.71）个月,定期复查CRP、ESR,监测肝肾功;观察X线、CT、MRI等影像学改变。根据手术前后及末次随访影像学资料分析畸形矫正度数和植骨融合情况。结果所有患者均未出现脊髓血管损伤感染等并发症,切口均一期愈合。根据Bridwell标准,骨融合时间9个月至1年,达到Ⅰ级骨性融合标准56例,Ⅱ级骨性融合标准4例。术后半年内血沉逐渐恢复,末次随访ESR均在正常范围（0~20 mm/h）;术后融合节段Cobb’s角丢失2.38°±1.86°。结论在有效的抗结核化疗基础上,通过一期前路病灶清除椎间植骨融合内固定手术,应用同种异体髂骨块作为椎间植骨材料,可摆脱供骨区并发症困扰,有效矫正后凸畸形、重建脊柱稳定性。

Objective To evaluate the therapeutic effect of one-stage anterior iliac crest allografting and instrumentation on the patients with spinal tuberculosis after radical debridement and decompression and assess the safety and efficacy. Methods Sixty patients,admitted in our department from Jan 2008 to Dec2012,were diagnosed with spinal tuberculosis,and their clinical data were analyzed retrospectively. These patients were treated with proper anterior or lateral anterior bone allografting and internal fixation after radical debridement and decompression. The follow-up period ranged from 9 to 36 months（ mean 22. 80 ± 7. 71months）. All the patients received chemotherapy for 12- 18 months and had brace immobilization for 3- 6months after operation. The general clinical data including liver function,renal function,high-sensitivity C-reactive protein（ CRP） and erythrocyte sedimentation rate（ ESR） were collected regularly. Changes in deformity correction and bony fusion were assessed by comparing preoperative,postoperative and latest imaging data obtained by X-ray imaging,computed tomography and magnetic resonance imaging. Results No neurological major vascular injuries or other complications were observed. According to Bridwell criteria,56 cases had grade Ⅰ fusion and 5 cases had grade Ⅱ fusion in 9- 12 months. The average kyphotic correction loss was 2. 38° ± 1. 86°. Conclusion Based on standard chemotherapy,the lesion is completely eliminated. The kyphosis is effectively corrected and spinal stability is reconstructed through one-stage anterior iliac crest allografting and instrumentation. This suggests that bone allograft is a suitable bone graft material for clinical surgery.