自体颗粒植骨与髂骨块植骨治疗单节段胸腰椎结核的疗效对比

Autogenous morselized bone garft versus autogenous iliac bone graft in the treatment of thoracic and lumbar spinal tuberculosis

目的回顾性观察自体颗粒植骨和髂骨块植骨在后路单节段胸腰椎结核手术中的临床疗效差异。方法2012年8月至2016年6月行后路病灶清除、椎体间植骨融合内固定术治疗的58例单节段胸腰椎结核患者,按植骨方式不同分为两组,颗粒组31例,髂骨组27例。比较两组手术时间、术中出血量,手术前后的VAS、ODI评分、神经功能恢复,在影像学资料上记录两组节段后凸Cobb角和椎间高度的改善及末次随访时的丢失、植骨融合时间。结果术后平均随访26（15~38）月,颗粒组手术时间（194.2±34.9）min、术中出血量（282.2±130.0）ml、植骨融合时间（5.8±1.0）月均优于髂骨组（240.0±61.5min、540.7±276.6ml、8.3±3.6月）（P〈0.05）。两组术后、末次随访时节段后凸Cobb角和椎间高度均较术前明显改善（P〈0.05）,末次随访时颗粒组节段后凸Cobb角和椎间高度丢失稍大于髂骨块组,但两组间无明显统计学差异（P〉0.05）。结论和髂骨植骨相比,颗粒骨植骨方便易行,术中出血少,植骨融合快,应用于单节段胸腰椎结核手术中,是一种安全、有效的植骨方式。

Objective Retrospectively evaluate the clinical outcomes of autogenous morselized bone graft and autogenous iliac bone graft for single-segment thoracic and lumbar spinal tuberculosis. Methods Between August 2012 to June 2016,58 cases of thoracic or lumbar spinal tuberculosis were treated by the surgery of interbody bone graft after debridement and fusion combined with posterior instrumentation.31 patients in group A underwent autogenous morselized bone graft and 27 cases in Group B underwent autogenous iliac bone graft. The surgical duration, blood loss, visual analog scale（VAS）, Oswestry Disability Index（ODI）, erythrocyte sedimentation rate（ESR）, C-Reactive protein（CRP）, The intervertebral height,segment-kyphotic angle were recorded and compared. The loss of segment kyphotic angle and intervertebral space height,and the bone fusion time on X-ray or CT scanning at the time point of post-operation and followups were recorded and compared. Results Final follow-up time ranged from 15 to 38 months,with an average of 26 months. The operation time was 194.2±34.9 min in group A and 240.0±61.5 minutes in group B（P〈0.05）. The blood loss was 282.2±130.0 ml in group A and 540.7±276.6 ml in group B（P〈0.05）. The bone fusion time was 5.8±1.0 months in group A and 8.3±3.6 months in group B（P〈0.05）. Both groups got good kyphosis correction and intervertebral height restoration. The loss of kyphosis correction and intervertebral height in group A were found to be more than those in group B, but with no significant difference between group A and group B（P〉0.05）. Conclusions Based on this retrospective study, autogenous morselized bone graft has a shorter surgical duration, lower blood loss and shorter bone fusion time compared with the autogenous iliac bone graft. The autogenous morselized bone graft is a safe and effective approach in treating single-segment thoracic and lumbar tuberculosis.