自体骨植骨联合抗结核药物局部缓释治疗脊柱结核的效果及对脊髓神经损伤的改善作用

Effects of auto-grafting combined with local antituberculosis drug delivery in the treatment of spinal tuberculosis and its influence on the relief of spinal cord injury

目的探讨自体骨植骨联合抗结核药物局部缓释治疗脊柱结核的效果及在改善脊髓神经损伤中的应用情况。方法将84例脊柱结核合并脊髓神经损伤患者随机分为观察组和对照组,各42例。两组均行一期病灶清除、自体骨植骨、内固定术,术前、术后给予正规抗结核。观察组采用OSTEOSET系列RBK药物载体型人工骨混合异烟肼、链霉素与自体骨混合后植骨,剩余RBK人工骨放置于病灶内,对照组仅采用自体骨植骨。统计手术时间、术中出血量;术后门诊随访时间12~59个月,中位时间为31个月,了解结核治愈率、植骨融合率、脊髓神经损伤改善及血沉(ESR)、疼痛视觉模拟评分(VAS)变化情况;复查X线,测量后凸角度Cobb角。结果两组手术时间、术中出血量、结核治愈率、植骨融合率比较差异无统计学意义(P>0.05),观察组治愈后复发率为0低于对照组的10.26%,差异有统计学意义(P<0.05);两组术后3个月、末次随访时ESR、VAS评分下降,Cobb角减少,与术前比较差异有统计学意义(P<0.001),且观察组术后3个月ESR、VAS低于对照组(P<0.001);两组末次随访神经功能分级(ASIA)为E级的几率分别为80.95%、73.81%高于治疗前的0、0,差异有统计学意义(P<0.001)。两组抗结核不良用药反应比较差异无统计学意义(P>0.05),且均未对抗结核治疗造成影响。结论一期病灶切除、植骨、内固定术中采用RBK药物载体型人工骨混合异烟肼、链霉素与自体骨混合后植骨治疗脊柱结核,可短时间内ESR下降明显,有利于降低痊愈后复发率,且不会增加不良用药反应。

Objective To investigate the effects of auto-grafting combined with local antituberculosis drug delivery in the treatment of spinal tuberculosis and its application in relief of spinal cord injury.Methods A total of 84 patients with spinal tuberculosis and spinal cord injury were randomly divided into the observation group and the control group,with 42 cases in each group.Both two groups were treated with one-stage debridement,auto-grafting and internal fixation,and they were given antituberculosis therapy before and after operation.The observation group was treated with OSTEOSET series RBK drug loaded artificial bone mixed with isoniazid,streptomycin and auto-grafting,and the remaining RBK artificial bone was placed in the lesions.The control group was only treated with auto-grafting.The operative time and intraoperative blood loss were statistically analyzed.All patients were followed up for 12-59 months,and the median time was 31 months.The cure rate of tuberculosis,the rate of bone graft fusion,the relief of spinal cord injury,changes of erythrocyte sedimentation rate(ESR)and visual analogue scale(VAS)score were observed.X-ray was used for review,and the Cobb angle was measured.Results There were no significant differences between the two groups in the operative time,intraoperative blood loss,the probability of artificial bone grafting rejection reactions,the cure rate of tuberculosis and rate of bone fusion rate(P>0.05).The recurrence rate in the observation group was 0,which was significantly lower than 10.26%in the control group(P<0.05).Three months after operation and at the end of follow-up,ESR and VAS scores and Cobb angle in two groups were decreased compared with before operation(P<0.001).ESR and VAS scores at 3 months after operation were lower in observation group than in the control group(P<0.001).The probabilities of grade E neurological function(ASIA)in the two groups at the end of follow-up were significantly higher than those before operation(80.95%and 73.81%vs 0 and 0)(P<0.001).There was no significant difference in adverse drug reactions between the two groups(P>0.05).Conclusion The application of RBK drug loaded artificial bone mixed with isoniazid,streptomycin and auto-grafting in one-stage debridement,bone grafting and internal fixation for treatment of spinal tuberculosis can significantly reduce ESR in a short time,which is conductive to reducing the recurrence rate after recovery,without increasing adverse drug reactions.