Ⅰ期前路病灶清除联合异体骨钛网置入治疗下颈椎结核疗效观察

One-stage anterior debridement combined with titanium cage fusion with allograft bone in the treatment of lower cervical tuberculosis

目的探讨Ⅰ期前路病灶清除联合异体骨钛网置入在下颈椎结核治疗中的方法与疗效。方法选取自2012年6月至2014年6月间解放军202医院骨科收治的30例下颈椎结核患者为研究对象,患者均采用Ⅰ期前路病灶彻底清除、减压、联合异体骨钛网置入治疗。记录并分析手术时间、出血量、后凸畸形角度、神经功能及并发症发生情况。结果手术时间为75~120 min,中位时间97 min;出血量130.0~350.0 ml,中位出血量233.2 ml。术前患者颈椎后凸畸形角度5°~57°,中位角度32°,术后角度为3°^-9°,中位角度-2.7°,术前、术后后凸畸形角度比较,差异有统计学意义(P<0.05)。术后患者神经功能均有不同程度的改善,与术前比较,差异有统计学意义(P<0.05)。患者均获得良好的骨性融合,无食管损伤、假体沉降移位、椎间塌陷等并发症,未出现与钛网置入相关的复发和感染情况。结论Ⅰ期前路病灶清除联合异体骨钛网置入治疗下颈椎结核可以有效恢复颈椎序列,提高椎间稳定性,安全有效,可避免因髂骨植骨引起的并发症。

Objective To investigate the clinical efficacy of one-stage anterior debridement combined with titanium cage fusion with allograft bone in the treatment of lower cervical tuberculosis.Methods A retrospective study was performed on 30 cases of patients with lower cervical tuberculosis who were admitted from June 2012 to June 2014.All the patients were performed one-stage anterior debridement,removing and decompressing thoroughly,combined with titanium cage fusion with allograft bone.The surgical time,the loss of the blood,improvement of neurological deficit,complications and the correction of kyphosis deformity were evaluated and analysised.Results The operation time ranged 75-120 minutes,with an average of 97 minutes.The loss of blood ranged 130.0-350.0 ml,with an average of 233.2 ml.The preoperative kyphotic angle ranged 5°-57°,with an average of 32°,the postoperative kyphotic angle ranged from 3°to-9°,with an average of-2.7°.There was significantly difference between preoperative and postoperative kyphosis(P<0.05).The neurological function of postoperative patients had different degrees of improvement than those before treatment(P<0.05).All patients achieved bone fusion without injuring esophagus,dislocation of instrument or other complications.These were no relapse or infection associated with titanium cage.Conclusion One-stage anterior instrument of plate and titanium cage fusion with allograft bone can efficiently regain the intervertebral height,supply initial stability and reconstruct sagittal alignment.Meanwhile,application of titanium cage can minimize the use of iliac bone and avoid the complication of the iliac graft area.