结构性同种异体冻干骨植入治疗腰椎结核

Structural allogeneic freeze-dried bone bone for treatment of lumbar tuberculosis

背景:同种异体冻干骨近些年越来越得到大家的关注,但对于它是否真正可作为自体骨的替代品在腰椎结核中进行植骨融合,目前仍无定论。目的:回顾性分析结构性同种异体冻干骨治疗腰椎结核的疗效。方法:选择行手术治疗的腰椎结核患者198例,其中男105例,女93例,年龄16-80岁;单节段感染病变168例,累及2个节段及2个以上的感染病变30例,存在明显腰椎畸形患者24例;129例患者行单纯腰椎前路植骨融合内固定手术,52例行单纯腰椎后路植骨融合内固定手术,17例行腰椎前后路联合植骨融合内固定手术,植骨材料为结构性同种异体冻干骨。分析患者术后神经功能、疼痛评分、畸形矫正、植骨融合程度、融合率及并发症发生情况。结果与结论:(1)198例患者随访时间为(30±11)个月;(2)末次随访时,198例患者的血沉、C-反应蛋白较术前明显改善(P <0.05),JOA评分和病变节段Cobb角较治疗前明显改善(P <0.05),神经功能经过治疗也有不同程度的缓解;(3)X射线片评估同种异体冻干骨融合时间为(9.3±2.2)个月,CT评估同种异体冻干骨融合时间为(12.7±3.1)个月;对Bridwell标准评估为I级融合的患者进行CT检查,141例骨小梁完全生成,阳性率为76%;(4)2例患者治疗后半年内植骨块骨折;6例患者术后1年内结核复发,其中2例伴有窦道形成;(5)结果表明在全身抗结核药物的基础上,应用同种异体冻干骨治疗腰椎结核是安全可行的。

BACKGROUND:Increasing attentions have been paid to allogeneic freeze-dried bone,but it is uncertain whether it can substitute the autologous bone in the treatment of lumbar tuberculosis.OBJECTIVE:To retrospectively analyze the therapeutic efficacy of structural allogeneic freeze-dried bone in the treatment of lumbar tuberculosis.METHODS:198 patients with lumbar tuberculosis scheduled for surgical treatment were selected,including 105 males and 93 females,16-80 years of age.There were 168 cases of single-segment infection,30 cases involving 2 segments and more than 2 infections,and 24 cases of obvious lumbar deformity.129 of the 198 patients underwent anterior lumbar interbody fusion and internal fixation,52 cases underwent simple posterior lumbar interbody fusion and internal fixation,and 17 cases underwent anterior and posterior lumbar interbody fusion and internal fixation.Structural allogeneic freeze-dried bone was used as the graft material.The postoperative neurological function,pain score,deformity correction,degree of bone fusion,fusion rate and complications were analyzed.RESULTS AND CONCLUSION:All the patients were followed up for(30±11)years.At the final follow-up,C-reactive protein expression(P<0.05),Japanese Orthopaedic Association score,Cobb angle(P<0.05)and neurologic function were significantly improved compared with the preoperative data.The time for bone fusion was(9.3±2.2)months as assessed by X-ray and(12.7±3.1)months as assessed by CT.Bridwell grade I patients underwent postoperative CT examination,and trabecular bone formation was implemented in 141 cases,with the positive rate of 76%.Two patients had fractures of the bone graft within 6 postoperative months and six patients had recurrent tuberculosis,two of whom had sinus formation.All these findings indicate that on the basis of systemic anti-tuberculosis drugs,it is safe and feasible to treat lumbar tuberculosis with allogeneic freeze-dried bone.