载利福霉素钠硫酸钙与自体骨植骨在治疗胸腰椎结核中的疗效比较

Comparison of therapeutic effects between calcium sulfate incorporated with rifamycin sodium and autologous bone grafting in the treatment of thoraco-lumbar tuberculosis

目的:评价在后入路病灶清除内固定术治疗胸腰椎结核中应用载利福霉素钠硫酸钙的有效性和安全性。方法:回顾性分析2019年6月至2022年8月甘肃省人民医院骨科干部病区收治的胸腰椎结核患者的临床资料,根据是否植入载利福霉素钠硫酸钙将患者分为载药组(单纯后入路病灶清除术联合载利福霉素钠硫酸钙植入)和植骨组(单纯后入路病灶清除术联合自体骨植入),初始纳入54例患者(载药组26例,植骨组28例),4例失访,最终纳入50例患者(载药组25例,植骨组25例)。病变节段:胸椎28例,胸腰段7例,腰椎15例。记录两组患者的手术时间、术中出血量、住院时间;术前、术后3个月及末次随访时的血红细胞沉降率(ESR)和C反应蛋白(CRP)水平;以及术前、术后3 d、术后3个月、术后6个月及末次随访时的Cobb角情况。结果:50例患者均获得随访,随访时间7~16个月。载药组和植骨组患者的手术时间[(168.04±17.22)min和(163.96±16.07)min]、术中出血量[(911.20±93.38)ml和(904.40±90.74)ml]、住院时间[(15.96±1.21)d和(15.28±1.31)d]差异均无统计学意义(t=0.750,P=0.282;t=0.068,P=0.795;t=3.651,P=0.062)。术后3个月时,载药组患者ESR[(26.48±2.76)mm/1 h]和CRP[(3.45±0.79)mg/L]水平均低于植骨组[(28.64±3.03)mm/1 h和(4.41±1.15)mg/L],差异均有统计学意义(t=2.639,P=0.011;t=3.454,P=0.001)。术后6个月和末次随访时,植骨组Cobb角度[(12.32±0.68)°、(12.43±0.76)°]均低于载药组[(12.84±1.02)°、(12.94±0.81)°],差异均有统计学意义(t=2.115,P=0.034;t=2.278,P=0.027)。结论:单纯后路病灶清除的同时植入载利福霉素钠硫酸钙治疗胸腰椎结核,能够达到彻底清除病灶,重建脊柱稳定性的目标。

Objective:To evaluate the efficacy and safety of calcium sulfate incorporated with rifamycin sodium in the treatment of thoraco-lumbar spinal tuberculosis through posterior approach lesion clearance and internal fixation surgery.Methods:A retrospective study was conducted in patients with thoraco-lumbar tuberculosis admitted to the Orthopedics,Cadre Ward of Gansu Provincial Hospital from June 2019 to August 2022.According to whether or not to implant rifamycin sodium calcium sulfate,the patients were divided into drug-loading group(simple posterior approach lesion removal combined with rifamycin sodium sulfate implantation)and bone graft group(simple posterior approach lesion removal combined with autologous bone implantation).Of the 54 cases initially included(26 cases in the drug-loading group and 28 cases in the bone graft group),4 were lost to follow-up,and 50 cases were finally included(25 cases in the drug-loading group and 25 cases in the bone graft group).Lesion segments:28 cases in the thoracic spine,7 cases in the thoraco-lumbar spine,and 15 cases in the lumbar spine.The operation time,blood loss,hospital stay,postoperative complications,levels of ESR and CRP preoperative,3 months postoperative and in the last follow-up were recorded,as well as the Cobb angles preoperative,3 day,3 months and 6 months postoperative and in the last follow-up.Results:All the 50 patients were followed up for 7-16 months.There was no significant difference in operation time((168.04±17.22)min vs.(163.96±16.07)min,t=0.750,P=0.282),blood loss(911.20±93.38)ml vs.(904.40±90.74)ml,t=0.068,P=0.795)and hospital stay((15.96±1.21)d vs.(15.28±1.31)d,t=3.651,P=0.062)between the two groups.The levels of ESR and CRP 3 months postoperative,in the drug-loaded group were significantly lower than those in the bone graft group((26.48±2.76)mm/1 h vs.(28.64±3.03)mm/1 h,t=2.639,P=0.011;(3.45±0.79)mg/L vs.(4.41±1.15)mg/L,t=3.454,P=0.001).The Cobb angles in the bone graft group 6 months postoperative and in the last follow-up were significantly lower than those in the bone graft group((12.32±0.68)°vs.(12.84±1.02)°,t=2.115,P=0.034;(12.43±0.76)°vs.(12.94±0.81)°,t=2.278,P=0.027).Conclusion:Simple posterior approach lesion removal combined with rifamycin sodium sulfate implantation for the treatment of thoraco-lumbar tuberculosis could achieve the goal of complete removal of lesions and reconstruction of spinal stability.