脊柱结核病灶清除并椎间支撑植骨术后并发症的防治

Prevention and treatment of complications after debridement and intervertebral support bone grafting for spinal tuberculosis

目的探讨脊柱结核病灶清除并椎间支撑植骨术后并发症的防治方法。方法2000年1月-2015年12月,宁夏医科大学总医院采用病灶清除并椎间支撑植骨术治疗脊柱结核患者326例。通过术后X线片、MRI及CT分析植骨融合情况及植骨相关并发症发生情况。结果所有患者术后化疗3~36(7.89±5.92)个月,结核灶全部治愈、植骨融合后停药,无新的结核灶形成。共使用348个植骨材料,其中髂骨290个,多根肋骨捆绑20个,肋髂骨捆绑26个,钛网12个。术后植骨融合过程中发生植骨倾斜9例(2.8%),植骨骨折8例(2.5%)、植骨吸收4例(1.2%)、植骨下沉3例(0.9%)、植骨移位1例(0.3%)、假关节形成1例(0.3%),相应给予延长制动时间、辅助外固定、再次手术彻底清除病灶或硬化骨、延长用药时间等措施,直至植骨融合、病灶治愈。结论脊柱结核病灶清除并椎间支撑植骨术后植骨融合过程中可能出现植骨块倾斜、骨折、吸收、下沉、移位及假关节形成等并发症,应注意预防并给予相应处理,促进病灶治愈和植骨融合。

Objective To investigate the prevention and treatment of complications after debridement and intervertebral support bone grafting for spinal tuberculosis.Methods From January 2000 to December 2015,326 patients with spinal tuberculosis were treated by debridement and intervertebral support bone graft in General Hospital of Ningxia Medical University.The spinal roentgenograph,MRI and CT were performed to analyze the fusion status and complications.Results All the patients received chemotherapy for 3-36(7.89±5.92)months.When the drug was discontinued,all the bone grafts were fused,all the tuberculosis focus were cured and no new tuberculosis focus formed.Totally 348 materials of bone grafts were used,including iliac crest 290,multiple rib bound 20,costal iliac crest bound 26 and titanium mesh 12.There were 9 cases(2.8%)of bone graft inclination,8(2.5%)of bone graft fracture,4(1.2%)of bone graft absorption,3(0.9%)of bone graft subsidence,1(0.3%)of bone graft displacement,and 1(0.3%)of pseudoarthrosis.Corresponding measures were given,such as prolonging the braking time,assisting the external fixation,removing the focus or sclerotic bone completely again,prolonging the medication time,until the fusion of bone graft and the healing of the focus.Conclusions Bone graft complications may occur during bone graft fusion after intervertebral bone grafting surgery for spinal tuberculosis,such as inclination,fracture,absorption,subsidence,displacement and pseudoarthrosis.Attention should be paid to prevention and corresponding treatment,so as to promote lesion healing and bone graft fusion.