钛笼与自体髂骨修复骨缺损在胸腰椎结核手术的疗效对比

Comparison of curative effect of titanium cage and autogenous iliac bone repairing bone defect in the surgical treatment of thoracic and lumbar spinal tuberculosis

目的探讨钛笼与自体髂骨修复骨缺损在胸腰椎结核手术治疗的疗效。方法纳入2014年12月~2016年12月于本院治疗的47例胸腰椎结核患者,均采用后路一期病灶清除联合植骨融合与椎弓根螺钉系统内固定治疗,将采用钛笼植骨融合的25例患者设为钛笼组,采用自体髂骨融合的22例患者设为髂骨组。比较两组患者手术相关指标、临床疗效及并发症发生情况。结果钛笼组手术时间、出血量显著低于髂骨组,差异有统计学意义(P<0.05),两组住院时间、植骨融合时间差异无统计学意义(P>0.05);两组术后1周、3个月、末次随访的Cobb角、VAS评分、ESR均显著降低,末次随访钛笼组Cobb角显著低于髂骨组,差异有统计学意义(P<0.05);两组末次随访Frankel分级较术前均显著改善,组间差异无统计学意义(P>0.05);两组术后并发症差异无统计学意义(P>0.05)。结论后路一期病灶清除联合植骨融合与椎弓根螺钉系统内固定手术中,采用钛笼植骨与自体髂骨融合均能取得较为良好的近远期疗效,但钛笼植骨手术耗时以及出血量较少,可减少远期Cobb角丢失。

Objective To compare the curative effect of titanium cage and autogenous iliac bone repairing bone defect in the surgical treatment of thoracic and lumbar spinal tuberculosis.Methods From December 2014 to December 2016,47 patients with thoracolumbar tuberculosis who were treated in our hospital were selected as the study subjects,and the medical records were retrospectively analyzed.All patients underwent posterior one-stage focus clearance combined with bone graft fusion and pedicle screw system internal fixation treatment.Twenty-five patients received titanium cage bone fusion were selected as titanium cage group,and 22 patients received autogenous iliac bone fusion were set as the iliac bone group.The surgical related indicators,clinical effect and incidence of complications were compared between the two groups.Results The operation time and blood loss of the titanium cage group were significantly lower than those of the iliac bone group,and the differences were statistically significant(P<0.05).There was no significant difference in hospitalization time and bone graft fusion time between the two groups(P>0.05).The Cobb angle,VAS score and erythrocyte sedimentation rate(ESR)in two groups were significantly decreased at postoperative 1 week,3 months and the last follow-up.The Cobb angle of the titanium cage group was significantly lower than that of the iliac bone group at the last follow-up,the difference was statistically significant(P<0.05).The Frankel grading at the last follow-up in the two groups was significantly improved compared with preoperation.There was no significant difference between the two groups(P>0.05).There was no significant difference in postoperative complications between the two groups(P>0.05).Conclusion Posterior one-stage focus clearance combined with bone graft fusion and pedicle screw system internal fixation treatment using the titanium cage bone grafting and autogenous ilium bone fusion can achieve better short-term and long-term results,but titanium cage bone graft surgery takes less time and less blood loss,and the loss of long-term Cobb angle can be reduced.