经椎弓根入路不同植骨材料内固定治疗胸椎结核

Internal fixation with different bone grafts via pedicle approach for treatment of thoracic spinal tuberculosis

背景:对于脊柱结核病灶清除后的骨质缺损,可以选择自体髂骨、自体肋骨、钛网加同种异体骨等多种植骨材料。目的:对比椎弓根入路不同植骨材料内固定治疗胸椎结核的效果。方法:纳入40例胸椎结核患者,其中18例伴有截瘫,15例存在后凸畸形,经正规抗结核治疗2-4周行后路椎弓根系统内固定,一期经椎弓根入路病灶清除植骨融合内固定,根据植骨材料的不同分为自体髂骨组、自体肋骨组、钛网加同种异体骨组。治疗后随访24个月,观察病灶愈合、植骨融合、截瘫恢复、后凸畸形矫正及不良反应发生率。结果与结论:自体髂骨组植骨融合时间短于自体肋骨组、钛网加同种异体骨组(P<0.05),后两组间植骨融合时间比较差异无显著性意义。3组均未发生植骨块及钛网脱落、断裂与移位,无骨不连及假关节等现象,无结核病灶复发。截瘫与脊柱后凸畸形患者经3-6个月的对症治疗,肌力基本恢复,脊柱后凸畸形基本矫正。表明自体髂骨治疗效果最好,自体肋骨、钛网加同种异体骨治疗效果相当。

BACKGROUND： Lots of bone graft materials such as autologous iliac bone, autologous rib, titanium mesh plus allograft are available in the treatment of bone defects after spinal tuberculosis debridement. OBJECTIVE： To compare the fixation effect of different kinds of bone graft materials via pedicle approach fixation for treatment of thoracic spinal tuberculosis. METHODS： Totally 40 patients with thoracic spinal tuberculosis were enrolled, including 18 patients accompanied with paraplegia and 15 patients accompanied with kyphosis deformity. Both of them were subjected to by standard anti-tuberculosis treatment for 2-4 weeks and consequent posterior pedicle screw fixation combined with debridement/bone grafting fusion. They were grouped by the variables of bone graft materials： autologous iliac bone, autologous rib, titanium mesh plus allograft groups. All patients were followed up for 24 months. The lesion healing, bone graft fusion, rehabilitation of paraplegia, correction of kyphosis and incidence of adverse reaction were observed. RESULTS AND CONCLUSION： The time of bone graft fusion in the autologous iliac bone group was shorter than that in the autologous rib and titanium mesh plus allograft groups（P〈0.05）, and there was no significant difference between autologous rib and titanium mesh plus allograft groups. No adverse phenomenons such as grafts and titanium mesh falling off, fracture and displacement, nonunion and pseudarthrosis, tuberculosis recurrence were found in these three groups. After the symptomatic therapy for 3-6 months, the muscle strength of patients with paraplegia and spinal kyphosis deformity basically recovered, spinal kyphosis deformity was basically corrected. These results demonstrate that the treatment effect of autologous iliac bone is the best; however, the treatment effect of autologous rib is as good as the titanium mesh plus allograft.