颗粒植骨与横突植骨治疗单节段胸腰椎结核的短期疗效比较

Comparison of short term effects of granular bone graft and transverse bone graft in the treatment of single segmental thoracic and lumbar spinal tuberculosis

目的比较颗粒植骨与横突植骨修复椎骨缺损治疗单节段胸腰椎结核的短期疗效。方法回顾性分析2011-2015年行后路病灶清除、植骨融合内固定治疗的52例单节段胸腰椎结核患者的病例资料,其中颗粒植骨组25例,横突植骨组27例。观察比较两组患者腰痛视觉模拟评分(VAS)、红细胞沉降率(ESR)、C反应蛋白(CRP)水平、Cobb角的矫正及丢失、神经功能恢复情况、植骨融合时间以及并发症发生情况。结果 52例患者随访13~23个月,腰痛VAS、ESR、CRP均较术前明显改善(P<0.05)。两组患者Cobb角矫正度无明显差异(P>0.05),但随访期间颗粒植骨组Cobb角丢失较横突植骨组明显(P<0.05)。颗粒植骨组融合时间(5.0±0.9个月)短于横突植骨组(6.3±1.0个月,P<0.05)。随访末两组患者神经功能均得到明显改善,且组间比较差异无统计学意义(P>0.05)。两组均未见严重并发症。结论颗粒植骨与横突植骨治疗单节段胸腰椎结核均可获得良好的短期疗效,但前者植骨融合时间更短。

Objective To compare the short term effects of granular bone graft and transverse bone graft in the treatment of single segmental thoracic and lumbar spinal tuberculosis. Methods The data of 52 patients with single segmental thoracic and lumbar spinal tuberculosis treated by posterior debridement, bone graft fusion and internal fixation in our department from 2011 to 2015 were retrospectively analyzed, who were divided into granular bone graft group（n=25） and transverse bone graft group（n=27）. Visual analogue scale（VAS） score, erythrocyte sedimentation rate（ESR）, C-reactive protein（CRP）, the correction and loss of Cobb angle, the recovery of neurological function, the time of bone graft fusion and complications were observed and compared. Results All patients were followed up for 13 to 23 months. VAS scores, ESR and CRP improved significantly after operation in all patients（P〈0.05）. No significant differences were found in Cobb angle correction between the two groups（P〈0.05）, but granular bone graft group were found having more Cobb angle loss than transverse bone graft group during the follow-up（P〈0.05）. The bone fusion time of granular bone graft was shorter than transverse bone graft（P〈0.05）, which were 5.0±0.9 months and 6.3±1.0 months, respectively. Neurological function all improved at the end of follow-up, and no severe complications were observed. ConclusionGranular bone graft and transverse bone graft can both achieve good clinical efficacy in the treatment of single segmental thoracic and lumbar spinal tuberculosis, but the former has a shorter bone fusion time.