血小板源性生长因子联合同种异体骨移植治疗脊柱结核疗效观察

Efficacy of platelet-derived growth factor combined with allograft bone transplantation in the treatment of spinal tuberculosis

目的探讨血小板源性生长因子(PDGF)联合同种异体骨移植治疗脊柱结核的疗效及安全性。方法选择2018年8月至2023年8月青海省第四人民医院收治的177例腰椎结核患者为研究对象。根据移植骨来源将患者分为对照组(n=49)和观察组(n=128)。患者术前均进行至少2周的正规四联抗结核化学治疗。对照组患者给予PDGF联合自体骨移植,观察组患者给予PDGF联合同种异体骨移植。记录2组患者的手术时间、术中出血量、住院时间;比较2组患者术前及术后1、3、6个月的全血红细胞沉降率(ESR)、血清C-反应蛋白(CRP)水平;术前进行CT及核磁共振成像(MRI)检查,术后待骨融合完成后复查CT及MRI,比较术前与术后Cobb角变化;术前及术后1、3、6个月,采用视觉模拟评分法(VAS)评估腰椎区域的疼痛程度,比较2组患者术前、术后VAS评分,并比较2组男性患者术前、术后VAS评分以及2组女性患者术前、术后VAS评分。结果观察组与对照组患者手术时间、住院时间比较差异无统计学意义(P>0.05)。观察组患者术中出血量显著少于对照组(P<0.05)。观察组与对照组患者术前、术后Cobb角比较差异均无统计学意义(P>0.05)。2组患者术后Cobb角与术前比较均显著降低(P<0.05)。2组患者术前及术后1、3、6个月的VAS评分均依次降低,组内两两比较差异均有统计学意义(P<0.05)。2组男性患者术前及术后1、3、6个月的VAS评分均依次降低,组内两两比较差异均有统计学意义(P<0.05)。2组女性患者术前及术后1、3、6个月的VAS评分均依次降低,组内两两比较差异均有统计学意义(P<0.05)。术前及术后1、6个月时,观察组与对照组患者VAS评分比较差异无统计学意义(P>0.05);术后3个月,观察组患者VAS评分显著低于对照组(P<0.05)。观察组男性患者术前及术后1、6个月的VAS评分与对照组男性患者比较差异无统计学意义(P>0.05);观察组男性患者术后3个月的VAS评分显著低于对照组男性患者(P<0.05)。观察组女性患者术前及术后1、6个月的VAS评分与对照组女性患者比较差异无统计学意义(P>0.05);观察组女性患者术后3个月的VAS评分显著低于对照组女性患者(P<0.05)。2组患者术前及术后1、3、6个月的ESR均依次降低,组内两两比较差异均有统计学意义(P<0.05)。2组患者术前及术后1、3、6个月的血清CRP水平均依次降低,组内两两比较差异均有统计学意义(P<0.05)。术前及术后1、3、6个月,观察组与对照组患者ESR比较差异均无统计学意义(P>0.05)。术前及术后1、6个月,观察组与对照组患者血清CRP水平比较差异无统计学意义(P>0.05);观察组患者术后3个月的血清CRP水平显著高于对照组(P<0.05)。结论PDGF联合同种异体骨移植治疗脊柱结核的效果与自体骨移植相当,但PDGF联合同种异体骨移植可显著减轻患者术后疼痛程度,提高患者的舒适度,避免自体骨移植带来的额外损伤,减轻患者的身体负担,可作为腰椎结核手术植骨一种安全、可靠的手术方式。

Objective To explore the efficacy and safety of platelet-derived growth factor(PDGF)combined with allograft bone transplantation in the treatment of spinal tuberculosis.Methods A total of 177 patients with lumbar tuberculosis admitted to the 4 th People′s Hospital of Qinghai Province from August 2018 to August 2023 were selected as the research subjects.Patients were divided into control group(n=49)and observation group(n=128)based on the source of the transplanted bone.All patients underwent at least 2 weeks of standard quadruple anti-tuberculosis chemotherapy before surgery.Patients in the control group received PDGF combined with autograft bone transplantation,while patients in the observation group received PDGF combined with allograft bone transplantation.The surgical duration,intraoperative blood loss,and length of hospital stay of patients in the two groups were recorded;the erythrocyte sedimentation rate(ESR)and serum C-reactive protein(CRP)levels of patients in the two groups were compared before surgery and at 1,3,6 months after surgery.Preoperative CT and magnetic resonance imaging(MRI)examinations were performed,and postoperative CT and MRI were performed after bone fusion was completed to compare the changes in Cobb angle before and after surgery.The visual analogue scale(VAS)was used to assess the pain degree in the lumbar region before surgery and at 1,3,6 months after surgery.The VAS scores of patients in the two groups,VAS scores of male patients in the two groups,and VAS scores of female patients in the two groups were compared before and after surgery,respectively.Results There was no statistically significant difference in surgical duration and length of hospital stay between the observation group and the control group(P>0.05).The intraoperative blood loss of patients in the observation group was significantly less than that in the control group(P<0.05).There was no statistically significant difference in Cobb angle before and after surgery between the two groups(P>0.05).The postoperative Cobb angle significantly decreased in both groups when compared to preoperative values(P<0.05).The VAS scores of patients in both groups decreased sequentially before surgery and at 1,3,6 months after surgery,with statistically significant differences in intra-group pairwise comparisons(P<0.05).The VAS scores of male patients in both groups decreased sequentially before surgery and at 1,3,6 months after surgery,with statistically significant differences in intra-group pairwise comparisons(P<0.05).The VAS scores of female patients in both groups also decreased sequentially before surgery and at 1,3,6 months after surgery,with statistically significant differences in intra-group pairwise comparisons(P<0.05).There was no statistically significant difference in VAS scores between the observation group and the control group before surgery and at 1,6 months after surgery(P>0.05);the VAS score of patients in the observation group was significantly lower than that in the control group at 3 months after surgery(P<0.05).There was no statistically significant difference in VAS scores between male patients in the observation group and male patients in the control group before surgery and at 1,3,6 months after surgery(P>0.05);the VAS score of male patients in the observation group was significantly lower than that in the control group at 3 months after surgery(P<0.05).There was no statistically significant difference in VAS scores between female patients in the observation group and female patients in the control group before surgery and at 1,6 months after surgery(P>0.05);the VAS score of female patients in the observation group was significantly lower than that in the control group at 3 months after surgery(P<0.05).The ESR of patients in both groups decreased sequentially before surgery and at 1,3,6 months after surgery,with statistically significant differences in intra-group pairwise comparisons(P<0.05).The serum CRP levels of patients in both groups also decreased sequentially before surgery and at 1,3,6 months after surgery,with statistically significant differences in intra-group pairwise comparisons(P<0.05).There was no statistically significant difference in ESR between the observation group and the control group before surgery and at 1,3,6 months after surgery(P>0.05).There was no statistically significant difference in serum CRP level between the observation group and the control group before surgery and at 1,6 months after surgery(P>0.05);the serum CRP level of patients in the observation group was significantly higher than that in the control group at 3 months after surgery(P<0.05).Conclusion The effect of PDGF combined with allograft bone transplantation in the treatment of spinal tuberculosis is comparable to that of autograft bone transplantation,but PDGF combined with allograft bone transplantation can significantly reduce postoperative pain degree,improve patient comfort,avoid additional damage caused by autograft bone transplantation,and reduce the physical burden on patients.It can be considered a safe and reliable surgical method for bone grafting in lumbar tuberculosis surgery.