自体颗粒植骨与髂骨块植骨在单节段胸腰椎结核中的应用对照研究

A Controlled Study on the Application of Autologous Granulated Bone Graft and Iliac Bone Block Graft in Single-segment Thoracolumbar Tuberculosis

目的比较自体颗粒植骨与髂骨块植骨在单节段胸腰椎结核中的应用效果。方法选取2019年11月—2021年10月吉林省结核病医院收治的64例单节段胸腰椎结核患者作为研究对象,按照随机数表法分为对照组(32例)与研究组(32例)。两组均开展椎体间植骨融合术治疗,研究组采用自体颗粒植骨,对照组采用自体髂骨块植骨。针对两组术中及术后情况、并发症,术前与术后7 d时疼痛及神经功能、术前与术后6个月时椎间高度与Cobb角进行比较。结果研究组手术操作时间(140.52±18.65)min、术中失血量(426.65±55.56)mL较对照组(156.32±30.42)min、(514.65±48.60)mL低,差异有统计学意义(t=2.505、6.774,P<0.05),两组住院时间差异无统计学意义(P>0.05)。研究组术后并发症发生率为3.13%,与对照组的9.38%比较,差异无统计学意义(χ^(2)=0.267,P>0.05)。术后7 d时两组疼痛视觉模拟评分法(VAS)与日本骨科学会(JOA)评分比较,差异无统计学意义(P>0.05)。术后6个月时研究组椎间高度(15.30±3.00)cm与Cobb角(8.32±2.02)°较对照组(17.60±2.98)cm、(10.46±2.18)°低,差异有统计学意义(t=3.077、4.073,P<0.05)。结论相较于自体髂骨块植骨,自体颗粒植骨能够有效缩短单节段胸腰椎结核患者的手术时间,减少术中失血量,促进椎间高度与Cobb角恢复,具有临床应用价值。

Objective To compare the effect of autologous granular bone graft and iliac bone block graft in singlesegment thoracolumbar spinal tuberculosis.Methods 64 patients with single level thoracolumbar tuberculosis admitted to tuberculosis Hospital of Jilin Province from November 2019 to October 2021 were selected as the study subjects and divided into,the control group(32 cases)and the study group(32 cases)according to a random number table.two groups were treated with intervertebral body graft fusion,with the study group using autologous granular bone graft and the control group using autologous iliac bone block graft.Intraoperative and postoperative conditions,complications,pain and neurological function at 7 d preoperatively and postoperatively,and intervertebral height and Cobb angle at 6 months preoperatively and postoperatively were compared between the two groups.Results The operative time and intraoperative blood loss in the study group were(140.52±18.65)min and(426.65±55.56)mL,respectively,lower than those in the control group(156.32±30.42)min and(514.65±48.60)mL,the difference was statistically significant(t=2.505,6.774,P<0.05),there was no statistically significant difference in hospital stay between the two groups(P>0.05).There was no statistically significant difference in postoperative complications rate between the study group(3.13%)and the control group(9.38%)(χ^(2)=0.267,P>0.05).At 7 days after surgery,there was no statistically significant difference between the two groups'pain visual analogue scale(VAS)and the Japanese Orthopedic Association(JOA)scores(P>0.05).At 6 months after surgery,the intervertebral height and Cobb angle in the study group were(15.30±3.00)cm and(8.32±2.02)°lower than those in the control group(17.60±2.98)cm and(10.46±2.18)°,the difference was statistically significant(t=3.077,4.073,P<0.05).Conclusion Compared with autologous iliac bone block implant,autologous granular bone graft can effectively shorten the operation time,reduce intraoperative blood loss,and promote the recovery of intervertebral height and Cobb angle in patients with single-segment thoracolumbar spine tuberculosis,which has clinical application value.