前路病灶清除植骨融合内固定联合抗骨质疏松治疗老年脊柱结核

Anterior Debridement,Bone Graft Fusion,and Internal Fixation Combined with Anti-Osteoporosis Treatment in Elderly Patients with Spinal Tuberculosis

目的探讨前路病灶清除植骨融合内固定术结合抗骨质疏松治疗老年脊柱结核合并骨质疏松症的临床效果。方法本研究选取2021年3月至2022年6月收治的98例脊柱结核合并骨质疏松症的老年患者,采取随机数字表法分为观察组48例,男28例,女20例;年龄60~73岁,平均(65.35±8.20)岁。对照组50例,男28例,女22例;年龄62~75岁,平均(67.20±7.60)岁。两组均接受前路病灶清除植骨融合内固定术,术前术后均接受抗结核药物治疗12~18个月。观察组在此基础上接受抗骨质疏松治疗,包括碳酸钙D3、阿法骨化醇、唑来膦酸注射液,对照组则未使用正规抗骨质疏松药物。记录两组患者的手术时间、术中出血量,对比术后两组卧床时间、红细胞沉降率(erythrocyte sedimentation rate,ESR)、疼痛视觉模拟评分(visual analogue scale,VAS)、脊柱后凸Cobb角、植骨融合时间、术后并发症以及末次随访骨密度恢复情况,并进行统计分析。结果所有患者均获随访,随访时间13~17个月,平均随访(14.00±2.30)个月。在成功完成手术治疗的98例腰椎结核患者中,观察组经抗骨质疏松症治疗表现出显著优势。观察组患者的术后卧床时间为(3.95±0.76)周,明显短于对照组的(4.58±1.01)周(P=0.027)。此外,术后6个月观察组的ESR为(27.60±3.40)mm/h,对照组为(30.20±2.97)mm/h,差异有统计学意义(P=0.008);观察组的术后VAS评分为(2.20±0.83)分,与对照组的(3.40±0.77)分相比,差异有统计学意义(P=0.001)。观察组植骨融合时间为(3.95±0.43)个月,明显短于对照组的(4.57±0.79)个月,差异有统计学意义(P=0.003)。短期随访提示,观察组脊柱后凸Cobb角矫正度数为(5.93±0.94)°,对照组为(6.73±1.80)°,两组差异无统计学意义(P=0.081)。在末次随访中,观察组骨质疏松检测的T值为(-2.40±0.39),显著高于对照组的(-3.20±0.40),差异有统计学意义(P<0.001)。观察组术后的并发症发生率为5.00%,低于对照组的9.10%(P=0.662)。结论前路病灶清除植骨融合内固定术结合正规抗骨质疏松治疗老年脊柱结核合并骨质疏松症,在术后康复、炎症指标、骨质疏松、疼痛缓解和植骨融合等方面取得显著的优势,可为相关临床实践提供有益的参考。

Objective To evaluate the clinical efficacy of anterior debridement,bone graft fusion,and internal fixation combined with anti-osteoporosis treatment in elderly patients with spinal tuberculosis and osteoporosis.Methods This study encompassed 98 elderly patients with spinal tuberculosis and osteoporosis who were treated from March 2021 to June 2022.Utilizing a random number table method,the patients were divided into two groups:The observation group,consisting of 48 patients(28 males and 20 females),with an average age of(65.35±8.20)years,ranging from 60 to 73 years old,and the control group,comprising 50 patients(28 males and 22 females),aged between 62 and 75 years,with a mean age of(67.20±7.60)years.Both groups underwent anterior debridement,bone graft fusion,and internal fixation,accompanied by anti-tuberculosis treatment administered pre-and post-operatively for 12~18 months.The observation group additionally received anti-osteoporosis treatment,encompassing calcium carbonate D3,alfacalcidol,and zoledronic acid injection,whereas the control group did not receive formal anti-osteoporosis medication.Parameters such as surgical time,intraoperative blood loss,post-operative bed rest duration,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)for pain assessment,kyphotic Cobb angle,bone graft fusion time,post-operative complications,and bone mineral density(BMD)at the final follow-up were recorded and statistically analyzed.Results All patients were followed up for a duration ranging from 13 to 17 months,with an average follow-up period of(14.00±2.30)months.The observation group demonstrated notable benefits from the anti-osteoporosis treatment.Specifically,the post-operative bed rest time in the observation group was(3.95±0.76)weeks,which was considerably shorter than the(4.58±1.01)weeks required by the control group(P=0.027).At the six-month post-surgery mark,the ESR in the observation group measured at(27.60±3.40)mm/h,whereas the control group recorded an ESR of(30.20±2.97)mm/h(P=0.008).Additionally,the VAS in the observation group stood at(2.20±0.83),notably lower than the(3.40±0.77)score observed in the control group(P=0.001).Furthermore,the bone graft fusion time in the observation group was(3.95±0.43)months,significantly shorter compared to the(4.57±0.79)months in the control group(P=0.003).Regarding the correction degree of kyphotic Cobb angle,the observation group achieved(5.93±0.94)°,while the control group reached(6.73±1.80)°,although this difference was not statistically significant(P=0.081).Upon the final follow-up,the T-score for osteoporosis in the observation group was(-2.40±0.39),which was significantly higher than the(-3.20±0.40)recorded in the control group(P<0.001).Lastly,the incidence of post-operative complications in the observation group was 5.00%,which was lower than the 9.10%seen in the control group,albeit this difference was not statistically significant(P=0.662).Conclusion Anterior debridement,bone graft fusion,and internal fixation combined with formal anti-osteoporosis treatment show significant advantages in post-operative recovery,inflammatory markers,osteoporosis,pain relief,and bone graft fusion in elderly patients with spinal tuberculosis and osteoporosis.This approach provides valuable insights for related clinical practices.