前路颈椎结核病灶清除联合钛网与同种异体骨环支撑的临床疗效观察
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摘要
目的探讨钛网与同种异体骨环支撑在颈椎前路病灶清除术中应用的安全性、有效性及临床疗效。方法回顾性分析2010年6月至2017年6月于我科行经前路颈椎结核病灶清除、钛网或同种异体骨环植骨融合内固定术治疗的23例颈椎结核患者的临床资料,将其分为同种异体骨环组(n=11)和钛网组(n=12)。对2组患者的手术时间、出血量、住院时间、ESR变化(红细胞沉降率)、植骨融合率、内植物塌陷情况进行比较。结果钛网组和同种异体骨环组手术时间、出血量、住院时间等指标差异无统计学意义(P>0. 05)。同种异体骨环组术后3个月红细胞沉降率为(19. 2±5. 8) mm/h,钛网组术后3个月红细胞沉降率为(31. 7±6. 1) mm/h,差异有统计学意义(P <0. 05)。随访1年,钛网组有5例出现内植物塌陷(5/12),同种异体骨环组出现1例内植物塌陷(1/11)。随访期间,1例患者因多重耐药结核菌抗结核治疗无效导致融合失败及内固定移位,2组其余患者均获得良好融合,无内固定移位及断裂。结论前路颈椎结核病灶清除术后钛网支撑及同种异体骨环支撑可取得满意的临床效果,移植物无明显排斥反应,均有较高的植骨融合率,但同种异体骨环具有较低的内植物塌陷率,可作为前路清除术后椎体结构缺损的理想替代材料用于颈椎结核的临床治疗。
Objective To evaluate the safety,feasibility and the clinical effects of anterior transplantation with allograft and titanium mesh in the treatment of cervical tuberculosis. Methods From June 2010 to June 2017,the clinical data of 23 cases of cervical tuberculosis who were treated with allograft or titanium mesh combined with internal fixation after radical debridement in our department were analyzed retrospectively. All patients were divided into allograft group( n = 11) and titanium mesh group( n = 12). The operation time,amount of bleeding,hospital stays,ESR,graft fusion satisfaction rate and graft collapse rate between two groups were compared. Results The difference of the operation time,intraoperative blood loss and average length of hospital stay between two groups were not statistically significant( P > 0. 05). The mean ESR level was( 19. 2 ± 5. 8) mm/h in allograft group,and( 31. 7 ± 6. 1) mm/h in titanium mesh group at 3 months after the operation,the difference was statistically significant( P < 0. 05). There were 5 cases with graft collapse in titanium mesh group,1 case with graft collapse in allograft group. During the period of follow-up,all of patients showed bone graft fusion except 1 case of invalid for multidrug-resistant mycobacterium tuberculosis caused by anti-tuberculosis treatment. Conclusion The clinical effects of anterior transplantation with allograft and titanium mesh in the treatment of cervical tuberculosis is safety and feasibility without obvious graft rejection and high rate of bone graft fusion. Meanwhille,allograft maybe the ideal substitute of autologous iliac bone for the clinical treatment of cervical tuberculosis with low rate of graft collapse.
Objective To evaluate the safety,feasibility and the clinical effects of anterior transplantation with allograft and titanium mesh in the treatment of cervical tuberculosis. Methods From June 2010 to June 2017,the clinical data of 23 cases of cervical tuberculosis who were treated with allograft or titanium mesh combined with internal fixation after radical debridement in our department were analyzed retrospectively. All patients were divided into allograft group( n = 11) and titanium mesh group( n = 12). The operation time,amount of bleeding,hospital stays,ESR,graft fusion satisfaction rate and graft collapse rate between two groups were compared. Results The difference of the operation time,intraoperative blood loss and average length of hospital stay between two groups were not statistically significant( P > 0. 05). The mean ESR level was( 19. 2 ± 5. 8) mm/h in allograft group,and( 31. 7 ± 6. 1) mm/h in titanium mesh group at 3 months after the operation,the difference was statistically significant( P < 0. 05). There were 5 cases with graft collapse in titanium mesh group,1 case with graft collapse in allograft group. During the period of follow-up,all of patients showed bone graft fusion except 1 case of invalid for multidrug-resistant mycobacterium tuberculosis caused by anti-tuberculosis treatment. Conclusion The clinical effects of anterior transplantation with allograft and titanium mesh in the treatment of cervical tuberculosis is safety and feasibility without obvious graft rejection and high rate of bone graft fusion. Meanwhille,allograft maybe the ideal substitute of autologous iliac bone for the clinical treatment of cervical tuberculosis with low rate of graft collapse.
引文
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[8]汪凡栋,张智,郑佳状,等.钛网内固定系统重建胸腰段肿瘤切除后脊柱:稳定性及生物相容性[J].中国组织工程研究,2015,19(21):3377-3381. doi:10. 3969/j. issn. 2095-4344. 2015. 21. 018.
[9]曾忠友,严卫锋,吴鹏,等.改良270°椎管减压椎体前中柱重建治疗严重胸腰椎骨折[J].中国脊柱脊髓杂志,2016,26(5):388-394. doi:10. 3969/j. issn. 1004-406X. 2016. 05. 02.
[10]纪楠,李宏伟,王玄,等.Ⅰ期前路病灶清除联合异体骨钛网置入治疗下颈椎结核疗效观察[J].创伤与急危重病医学,2018,6(2):75-76. doi:10. 16048/j. issn. 2095-5561. 2018. 02. 04.
[11]李松凯,倪斌,蓝旭,等.一期前路病灶清除钛网植骨融合内固定治疗下颈椎结核[J].实用骨科杂志,2014,20(10):865-868.
[12]杨海青,段洪,闵捷,等.钛网植骨结合椎弓根钉棒内固定修复胸椎结核:重建脊柱生理曲度及稳定性[J].中国组织工程研究,2014,18(53):8590-8595. doi:10. 3969/j. issn. 2095-4344.2014. 53. 012.
[13]王解生.后路椎弓根螺钉固定及前路病灶清除后大块异体骨重建治疗合并椎体缺失的儿童胸腰椎结核的疗效观察[J].医学临床研究,2018,35(4):747-749. doi:10. 3969/j. issn. 1671-7171.2018. 04. 042.
[14]Suchomel P,Barsa P,Buchvald P,et al. Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion:a prospective study with respect to bone union pattern[J]. Eur Spine J,2004,13(6):510. doi:10. 1007/s00586-003-0667-z.
[15]郭海龙,魏庆广,邓强,等.一期前路同种异体髂骨块与自体髂骨块移植治疗胸腰椎结核的临床疗效对比[J].中华骨科杂志,2017,37(18):1121-1129. doi:10. 3760/cma. j. issn. 0253-2352.2017. 18. 001.
[16]魏庆广.一期前路同种异体髂骨块与自体髂骨块移植治疗胸腰椎结核临床疗效对比研究[D].乌鲁木齐:新疆医科大学,2016.
[17] Butura CC,Galindo DF. Implant placement in alveolar composite defects regenerated with rhBMP-2,anorganic bovine bone,and titanium mesh:a report of eight reconstructed sites[J]. Int J Oral Maxillofac Implants,2014,29(1):e139-146. doi:10. 11607/jomi. te53.
[18]周思佳,姜文学,尤佳.骨缺损修复材料:现状与需求和未来[J].中国组织工程研究,2018,22(14):2251-2258. doi:10.3969/j. issn. 2095-4344. 0754.
[19]Hirota M,Ikeda P,Tabuchi P,et al. Effects of ultraviolet photofunctionalization on bone augmentation and integration capabilities of titanium mesh and implants[J]. Int J Oral Maxillofac Implants,2017,32(1):52. doi:10. 11607/jomi. 4891.
[20]王鹏波,盛伟斌,王丙超,等.结构性同种异体冻干骨植入治疗腰椎结核[J].中国组织工程研究,2018,22(34):5439-5444. doi:10. 3969/j. issn. 2095-4344. 0678.
[2]Rezai AR,Lee M,Cooper PR,et al. Modern management of spinal tuberculosis[J]. Neurosurgery,1995,36(1):97-98.
[3]Programme GT,Organization WH. Global tuberculosis report 2012[M].World Health Organization,2012:1-100.
[4]Shi J,Wang Z,Li H,et al. Diagnostic performance of the urinary deoxypyridinoline in spinal tuberculosis[J]. Orthopedics,2012,35(6):e922. doi:10. 3928/01477447-20120525-36.
[5] Fischer,Charla R,Cassilly,et al. A systematic review of comparative studies on bone graft alternatives for common spine fusion procedures[J]. Eur Spine J,2013,22(6):1423-1435. doi:10. 1007/s00586-013-2718-4.
[6]Chen WJ,Wu CC,Jung CH,et al. Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis[J]. Clin Orthop Relat Res,2002,398(398):50-59.
[7]周劲松,陈建庭,金大地,等.结核分枝杆菌对材料粘附能力的体外实验研究[J].中国脊柱脊髓杂志,2003,13(11):670-673. doi:10. 3969/j. issn. 1004-406X. 2003. 11. 005.
[8]汪凡栋,张智,郑佳状,等.钛网内固定系统重建胸腰段肿瘤切除后脊柱:稳定性及生物相容性[J].中国组织工程研究,2015,19(21):3377-3381. doi:10. 3969/j. issn. 2095-4344. 2015. 21. 018.
[9]曾忠友,严卫锋,吴鹏,等.改良270°椎管减压椎体前中柱重建治疗严重胸腰椎骨折[J].中国脊柱脊髓杂志,2016,26(5):388-394. doi:10. 3969/j. issn. 1004-406X. 2016. 05. 02.
[10]纪楠,李宏伟,王玄,等.Ⅰ期前路病灶清除联合异体骨钛网置入治疗下颈椎结核疗效观察[J].创伤与急危重病医学,2018,6(2):75-76. doi:10. 16048/j. issn. 2095-5561. 2018. 02. 04.
[11]李松凯,倪斌,蓝旭,等.一期前路病灶清除钛网植骨融合内固定治疗下颈椎结核[J].实用骨科杂志,2014,20(10):865-868.
[12]杨海青,段洪,闵捷,等.钛网植骨结合椎弓根钉棒内固定修复胸椎结核:重建脊柱生理曲度及稳定性[J].中国组织工程研究,2014,18(53):8590-8595. doi:10. 3969/j. issn. 2095-4344.2014. 53. 012.
[13]王解生.后路椎弓根螺钉固定及前路病灶清除后大块异体骨重建治疗合并椎体缺失的儿童胸腰椎结核的疗效观察[J].医学临床研究,2018,35(4):747-749. doi:10. 3969/j. issn. 1671-7171.2018. 04. 042.
[14]Suchomel P,Barsa P,Buchvald P,et al. Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion:a prospective study with respect to bone union pattern[J]. Eur Spine J,2004,13(6):510. doi:10. 1007/s00586-003-0667-z.
[15]郭海龙,魏庆广,邓强,等.一期前路同种异体髂骨块与自体髂骨块移植治疗胸腰椎结核的临床疗效对比[J].中华骨科杂志,2017,37(18):1121-1129. doi:10. 3760/cma. j. issn. 0253-2352.2017. 18. 001.
[16]魏庆广.一期前路同种异体髂骨块与自体髂骨块移植治疗胸腰椎结核临床疗效对比研究[D].乌鲁木齐:新疆医科大学,2016.
[17] Butura CC,Galindo DF. Implant placement in alveolar composite defects regenerated with rhBMP-2,anorganic bovine bone,and titanium mesh:a report of eight reconstructed sites[J]. Int J Oral Maxillofac Implants,2014,29(1):e139-146. doi:10. 11607/jomi. te53.
[18]周思佳,姜文学,尤佳.骨缺损修复材料:现状与需求和未来[J].中国组织工程研究,2018,22(14):2251-2258. doi:10.3969/j. issn. 2095-4344. 0754.
[19]Hirota M,Ikeda P,Tabuchi P,et al. Effects of ultraviolet photofunctionalization on bone augmentation and integration capabilities of titanium mesh and implants[J]. Int J Oral Maxillofac Implants,2017,32(1):52. doi:10. 11607/jomi. 4891.
[20]王鹏波,盛伟斌,王丙超,等.结构性同种异体冻干骨植入治疗腰椎结核[J].中国组织工程研究,2018,22(34):5439-5444. doi:10. 3969/j. issn. 2095-4344. 0678.