新型可滑动椎弓根钉棒内固定系统治疗腰椎结核:对融合节段产生应力刺激促进植骨融合

A novel slidable pedicle screw-rod system for lumbar tuberculosis:promoting bone graft fusion by producing stress stimulation to fused segment

背景:腰椎结核的治疗主要包括保守治疗和手术治疗,对于骨质破坏明显、神经症状显著的患者多需手术治疗,植骨融合结合椎弓根螺钉内固定是主要的治疗方式之一。目的:探讨一种新型可滑动椎弓根钉棒应用于腰椎结核内固定治疗的可行性及临床效果。方法:收集2017年11月至2019年11月在大连医科大学附属第一医院接受腰椎结核病灶清除植骨融合、新型可滑动椎弓根钉棒系统内固定的18例患者资料,男11例,女7例,年龄37-71岁,平均55.2岁。采用日本骨科学会腰椎评分、疼痛目测类比评分和神经功能美国脊髓损伤协会分级评估患者腰椎功能恢复情况,另外观察椎间植骨融合、椎间高度变化情况。结果与结论:(1)所有患者均顺利完成手术,随访时间6-18个月;(2)与术前相比,患者术后3,6个月的目测类比评分显著下降,日本骨科学会评分显著改善,差异均有显著性意义(P<0.05);(3)术后不同随访期间影像学结果显示手术节段椎间高度出现不同程度降低,且在术后6个月左右逐渐稳定,但均未出现神经症状及内固定断裂等;(4)提示新型可滑动椎弓根钉棒系统可用于腰椎结核内固定治疗,可有效促进手术节段植骨融合,近期临床效果满意。

BACKGROUND:The treatment of lumbar tuberculosis mainly includes conservative and surgical treatments.Patients who present with obvious bone destruction and neurological symptoms need surgical treatment.Bone graft fusion combined with pedicle screw internal fixation is one of the main surgical methods.OBJECTIVE:To investigate the clinical effect and safety of a novel slidable pedicle screw-rod system in the treatment of lumbar tuberculosis.METHODS:Data of eighteen patients with lumbar tuberculosis who underwent lumbar fusion using the novel slidable pedicle screw-rod system at the First Affiliated Hospital of Dalian Medical University from November 2017 to November 2019 were collected.There were 11 males and 7 females,aged 37-71 years by average 55.2 years.The Japanese Orthopaedic Association score,Visual Analogue Scale score and American Spinal Injuries Association grading were used to assess the recovery of lumbar function after treatment,while X-ray and CT were used to evaluate the fusion situation and the height variation of the fused segment.RESULTS AND CONCLUSION:(1)All the 18 patients were successfully followed up for 6-18 months.(2)The Visual Analogue Scale score dropped significantly at 3 and 6 months postoperatively,while the Japanese Orthopaedic Association(JOA)score was increased significantly(P<0.05).(3)Imaging results revealed that the height of the fused segment decreased postoperatively,and became stabilized about 6 months after operation;however,there were no neurologic symptoms and no nail stick falling or fracture.(4)To conclude,the novel slidable pedicle screw-rod system can provide a satisfactory outcome in the treatment of lumbar tuberculosis and promote the decompression segment fusion effectively.