摘要
目的探讨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安全性、可行性及临床疗效。方法回顾性分析2012年1月至2015年6月于我科行一期前路病灶清除同种异体髂骨块或自体髂骨块植骨融合内固定术治疗的235例胸腰椎结核患者的临床资料，将其分为同种异体髂骨块组和自体髂骨块组。同种异体髂骨块组162例，男87例，女75例，年龄2-80岁，平均42．5岁；自体髂骨块组73例，男41例，女32例，年龄14-68岁，平均40．3岁。对比两组患者手术前后及末次随访资料，对两组患者的手术时间、术中出血量、住院时间、红细胞沉降率、C反应蛋白、视觉疼痛模拟（visual analogue scale，VAS）评分、日本骨科协会（Japanese Orthopaedic Association，JOA）评估治疗评分、美国脊柱损伤协会（American Spinal Injury Association，ASIA）脊髓损伤分级改善及植骨融合满意率进行分析。结果同种异体髂骨块组手术时间平均（122．41±30．55）min，明显少于自体髂骨块组（141．56±25．69）min，差异有统计学意义。术后组内的VAS评分、JOA评分、红细胞沉降率、C反应蛋白及ASIA分级均较术前明显改善，差异有统计学意义，但两组间比较的差异无统计学意义；同种异体髂骨块组术后3个月红细胞沉降率为（16．46±7．39）mm／h，明显高于自体髂骨块组（13．61±6．85）mm／h，差异有统计学意义。同种异体髂骨块组植骨融合时间（8．13±1．97）个月，较自体髂骨块组（5．37±1．72）个月明显延长，差异有统计学意义；末次随访时ASIA分级有效改善率及植骨融合满意率，两组的差异均无统计学意义。围手术期并发症：胃肠功能障碍5例（同种异体髂骨块组3例，自体髂骨块组2例），肺部感染6例（同种异体髂骨块组4例，自体髂骨块组2例）。术后并发症：后凸畸形4例（同种异体髂骨块组3例，自�
Objective To evaluate the safety, feasibility and clinical efficacy of one-stage anterior transplantation with iliac crest allograft or autologous in the treatment of thoracolumbar tuberculosis. Methods From January 2012 to June 2015, 235 cases of thoracolumbar tuberculosis were treated with allogeneic or autologous iliac crest graft combined with internal fixation during one-stage after radical debridement, which were reviewed retrospectively. These cases were divided into two groups： allograft group （162 cases） and autograft group （73 cases）. In allograft group, there were 87 males and 75 females, with a mean age of 42.5 （range 2-80） years. In autograft group, there were 41 males and 32 females, with a mean age of 40.3 （range 14-68） years. The operation time, bleeding volume, hospital stay, erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） level, visual analogue scale （VAS） scores, Japanese Orthopaedic Association （JOA） scores, the changes of American Spinal Injury Association （ASIA） scale for neurological classification of spinal and graft fusion satisfaction rate in each groups were evaluated respectively before and after surgery. Results The operation time was （122.41±30.55） rain in allograft group and （141.56±25.69） min in auto- graft group, the difference was statistically significant. The average hospital stay and bleeding volume were no significant difference between the two groups. In each group, VAS scores, JOA scores, ESR and CRP level and the changes of ASIA scale were sig- nificant difference between pre-and post-operation, but these index showed that there were no significant differences between the two groups. The mean ESR level was （16.46±7.39） mm/h in allograft group, and （13.61±_6.85） mm/h in autograft group 3 months after the operation. The fusion time （8.13 ± 1.97） months in aIlograft group was significantly longer than that in autograft group （5.37± 1.72） months, the difference was statistically significant.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2017年第18期1121-1129,共9页
Chinese Journal of Orthopaedics
关键词
结核
脊柱融合术
治疗结果
移植
同种
Tuberculosis
Spinal fusion
Treatment outcome
Transplantation, homologous
