| 胸椎结核手术中捆绑式多折段肋骨植骨、髂骨植骨及钛网植骨的比较分析 |
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投稿时间：2020-04-10
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| 作者 | Author | 单位 | Address | E-Mail |
| 汪翼凡 |
WANG Yi-fan |
浙江省中西医结合医院, 浙江 杭州 310000 |
Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310000, Zhejiang, China |
newbee929@hotmail.Com |
| 石仕元 |
SHI Shi-yuan |
浙江省中西医结合医院, 浙江 杭州 310000 |
Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310000, Zhejiang, China |
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| 郑琦 |
ZHENG Qi |
浙江省中西医结合医院, 浙江 杭州 310000 |
Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310000, Zhejiang, China |
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| 金阳辉 |
JIN Yang-hui |
浙江省中西医结合医院, 浙江 杭州 310000 |
Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310000, Zhejiang, China |
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| 马鹏飞 |
and MA Peng-fei |
浙江省中西医结合医院, 浙江 杭州 310000 |
Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2021年，第34卷，第1期，第73-80页 |
| DOI：10.12200/j.issn.1003-0034.2021.01.014 |
| 基金项目:杭州市科技计划项目（编号：20180533878） |
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中文摘要:目的：比较在胸椎结核经肋横突入路手术中，捆绑式多折段肋骨植骨、髂骨植骨和钛网植骨3种不同方法的临床应用效果。
方法：对2010年1月至2016年12月接受手术治疗的107例胸椎结核患者进行回顾性分析，根据手术中植骨方式的不同分为3组。107例患者均采用肋横突手术入路，彻底清除结核病灶坏死组织后，分别予以髂骨植骨（36例，A组），捆绑式肋骨植骨（35例，B组）以及钛网植骨（36例，C组）3种不同方式进行植骨，对3组患者的围手术期指标、术中植骨所需时间、术中失血量、病灶椎体前缘高度丢失率、Cobb角、植骨融合时间、脊髓神经恢复及Oswestry功能障碍指数进行比较。
结果：所有患者获得随访，时间13~24个月，术中植骨所需时间A组为（23.2±4.1） min，B组为（23.8±4.4） min，C组为（25.5±4.2） min，3组间比较差异无统计学意义（P>0.05）；术中出血量A组为（541.6±35.3） ml，B组为（46.8±27.8） ml，C组为（540.1±34.5） ml，3组间比较差异无统计学意义（P>0.05）。术前椎体前缘高度丢失率A组（46.0±3.1）%，B组（46.4±3.3）%，（45.3±3.6）%，末次随访时分别为（8.6±5.0）%、（8.1±4.2）%、（9.4±4.3）%，术前及末次随访3组比较差异均无统计学意义（P>0.05）。术前Cobb角A组为（35.1±4.8）°，B组为（35.2±4.5）°，C组为（35.2±4.5）°，术后3 d分别为（15.1±3.6）°、（15.3±3.1）°、（15.2±3.4）°，末次随访时分别为（17.7±3.3）°、（17.9±3.9）°、（18.6±3.6）°，术前、术后3 d及末次随访时3组间比较差异均无统计学意义（P>0.05）。植骨融合时间A组为（5.6±0.5）个月，B组为（5.6±0.6）个月，C组为（5.8±0.6）个月，3组比较差异无统计学意义（P>0.05）。末次随访Frankel分级：B级4例，C级7例，D级10例，E级86例，3组患者治疗后脊髓神经功能均有一定程度恢复，组间差异无统计学意义（P>0.05）。末次随访Oswestry功能障碍指数3组间差异无统计学意义（P>0.05）。
结论：经肋横突入路病灶清除捆绑式肋骨植骨、髂骨植骨及钛网植骨均能有效治疗胸椎结核，但捆绑式肋骨植骨可有效避免髂骨供区并发症，是髂骨移植的一种有效的替代方式，值得推广使用。 |
| 【关键词】结核,脊柱 植骨 脊柱融合术 |
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| Comparative analysis of binding multi-fold rib graft,iliac bone graft and titanium mesh graft during surgery of tuberculosis of thoracic vertebra |
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ABSTRACT Objective: To compare the clinical effects of three different methods of binding multi-fold rib graft,iliac bone graft and titanium mesh graft in tuberculosis of thoracic vertebra by approach of transverse rib process.
Methods: A hundred and seven patients with tuberculosis of thoracic vertebra received surgical treatment from January 2010 to December 2016 were retrospectively analyzed. The patients were divided into three groups according different methods of bone graft. The surgical approach of the transverse rib process was used in all 107 patients,after thoroughly remove the necrotic tissue of tuberculosis,three different bone grafts were used respectively including iliac bone graft (36 cases,group A),binding multi-fold rib graft (35 cases,group B),titanium mesh bone graft (36 cases,group C). Perioperative indexes,the time required for bone graft during operation,intraoperation blood loss,the loss rate of the anterior edge of the lesion,Cobb angle,postoperative bone graft fusion time,spinal nerve recovery and Oswestry Disability Index were compared among three groups.
Results: All the patients were followed up for 13 to 24 months,and the operation time required for bone graft was (23.2±4.1) min in group A,(23.8±4.4)min in group B,and (25.5±4.2) min in group C,with no statistically significant difference among three groups (P>0.05). Intraoperative blood loss was (541.6±35.3) ml in group A,(546.8±27.8) ml in group B,and (540.1±34.5) ml in group C,with no statistically significant difference among three groups(P>0.05). Preoperative anterior vertebral height loss rate was (46.0±3.1)% in group A,(46.4±3.3)% in group B,and (45.3±3.6)% in group B;at the final follow-up,the loss rate of anterior vertebral height among three groups was (8.6±5.0)%,(8.1±4.2)%,(9.4±4.3)%,respectively. There were no statistically significant differences before operation and final follow-up among three groups (P>0.05). Preoperative Cobb angle was (35.1±4.8)° in group A,(35.2±4.5)° in group B and (35.2±4.5)° in group C,with no statistically significant difference among three groups(P>0.05);postoperative at 3 days,Cobb angle in three groups was (15.1±3.6)°,(15.3±3.1)° and (15.2±3.4)°,respectively,there was no statistically significant difference among three groups (P>0.05);at the final follow-up,the Cobb angle among three groups was (17.7±3.3)°,(17.9±3.9)°,(18.6±3.6)°,respectively,with no statistically significant difference among three groups (P>0.05). The time of bone graft fusion was (5.6±0.5) months in group A,(5.6±0.6) months in group B and (5.8±0.6)months in group C,with no statistically significant difference among three groups (P>0.05). Frankel classification at the final follow-up,4 cases were grade B,7 cases were grade C,10 cases were grade D,and 86 cases were grade E. Spinal nerve function in all three groups recovered to a certain extent after treatment,with no statistically significant difference among three groups(P>0.05). Oswestry Disability Index at the final follow-up showed no statistically significant difference among three groups(P>0.05).
Conclusion: The approach of transverse rib process for debridement of lesions can effectively treat tuberculosis of thoracic vertebra by binding multi-fold rib graft,iliac bone graft and titanium mesh graft,but binding multi-fold rib graft can effectively avoid iliac bone donor complications,and is an effective alternative to iliac bone graft,which is worth popularizing. |
| KEY WORDS Tuberculosis,spinal Bone graft Spinal fusion |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 汪翼凡,石仕元,郑琦,金阳辉,马鹏飞.胸椎结核手术中捆绑式多折段肋骨植骨、髂骨植骨及钛网植骨的比较分析[J].中国骨伤,2021,34(1):73~80 |
| 英文格式: | WANG Yi-fan,SHI Shi-yuan,ZHENG Qi,JIN Yang-hui,and MA Peng-fei.Comparative analysis of binding multi-fold rib graft,iliac bone graft and titanium mesh graft during surgery of tuberculosis of thoracic vertebra[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(1):73~80 |
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