本文選題：胸腰椎結核　切入點：鈦籠植骨　出處：《福建醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的:分析比較鈦籠填充自體顆粒骨植骨與自體髂骨塊植骨在一期后路病灶清除植骨融合內固定治療胸腰椎結核的臨床療效。方法:回顧性分析2012年6月至2014年9月在福建醫(yī)科大學附屬第一醫(yī)院脊柱外科行一期后路病灶清除植骨融合內固定治療的51例胸腰椎結核患者,其中鈦籠植骨融合組(A組)25例,髂骨植骨融合組(B組)26例。觀察兩組的手術時間、出血量、手術前后脊髓神經功能Frankel分級,炎癥指標ESR,手術前后局部后凸畸形Cobb角矯正情況、植骨融合時間等,并進行分析比較。結果:所有患者術后病理檢查均證實為結核病變,隨訪時間6-30月,隨訪期內所有患者均達到骨性融合。A組術后1例患者出現(xiàn)病灶復發(fā),B組無出現(xiàn)結核病灶復發(fā),但有2例出現(xiàn)髂骨取骨區(qū)血腫、傷口愈合欠佳。術后無內固定物斷裂、假關節(jié)形成等并發(fā)癥,植骨達骨性融合時間A組6-12個月,平均8.00±2.14個月,B組5-12個月,平均6.92±1.85個月,二者差異無統(tǒng)計學意義(P0.05)。在矯正后凸畸形角度上A組平均矯正9.50±8.76°,B組平均矯正6.84±7.94°,末次隨訪丟失角度A組平均1.68±3.96°,B組平均1.95±3.02°,在改善神經功能、矯正后凸角度及末次隨訪矯正丟失角度上二者差異無統(tǒng)計學意義(P0.05)。A組平均手術時間202.16±53.20min,B組282.27±65.26min,A組平均住院時間30.44±9.30天,B組為44.35±13.53天,A組顯著低于B組,兩組在手術時間、住院時間上差異有統(tǒng)計學意義(P0.05),術中出血量A組平均為712.40±419.34ml,B組951.92±799.69ml,二者比較無統(tǒng)計學意義(P0.05)。A組術前血沉平均60.76±20.19mm/h,術后1周血沉平均45.28±17.68mm/h,術后3個月血沉平均29.72±16.97mm/h,B組術前血沉平均53.69±31.69mm/h,術后1周血沉平均37.00±25.52mm/h,術后3個月血沉平均24.54±17.32mm/h,兩組在術前、術后1周、術后3月的時間點上ESR差異無統(tǒng)計學意義(P0.05),術后1周、術后3個月ESR較術前有明顯改善,差異有統(tǒng)計學意義(P0.05)。結論:(1)胸腰椎結核行一期后路病灶清除后置入填充自體顆粒骨的鈦籠進行植骨融合內固定是安全可行的,其臨床療效對比髂骨植骨無明顯差異。(2)與髂骨植骨融合相比,一期后路病灶清除鈦籠植骨融合內固定術可有效減少手術時間,縮短患者住院時間,同時可避免術后出現(xiàn)髂骨區(qū)疼痛、血腫等并發(fā)癥,而遠期隨訪矯正角度的丟失及融合時間無顯著差別。(3)一期后路結核病灶清除應用鈦籠植骨融合內固定治療脊柱結核,術后可有效矯正胸腰椎結核后凸畸形且可獲得即刻的穩(wěn)定性,臨床療效明顯,長期療效有待進一步觀察。
[Abstract]:Objective: to compare the clinical efficacy of titanium cage with autologous grafted bone graft and autogenous iliac bone graft in the treatment of thoracolumbar tuberculosis by posterior debridement, bone grafting and internal fixation. Methods: from June 2012 to 2014, a retrospective analysis was made on the treatment of thoracolumbar tuberculosis. In September, 51 patients with thoracolumbar tuberculosis were treated with posterior debridement, bone grafting, fusion and internal fixation in spinal surgery department of the first affiliated Hospital of Fujian Medical University. There were 25 cases in group A and 26 cases in group B in titanium cage bone graft fusion group and iliac bone graft fusion group respectively. The operation time, blood loss, Frankel grade of spinal cord nerve function, inflammation index, Cobb angle correction of local kyphosis before and after operation were observed. Results: all the patients were proved to be tuberculosis by pathological examination after operation, and the follow-up time was 6 to 30 months. During the follow-up period, all the patients achieved bone fusion. One patient in group A had recurrence of foci and no recurrence of tuberculosis in group B, but there were 2 cases of hematoma in iliac bone extraction area, which resulted in poor wound healing and no fracture of internal fixation after operation. The time of bone grafting to bony fusion was 6-12 months (mean 8.00 鹵2.14 months) and 5-12 months (mean 6.92 鹵1.85 months) in group B. There was no significant difference between the two groups in terms of correction of kyphosis. The average correction of group A was 9.50 鹵8.76 擄and that of group B was 6.84 鹵7.94 擄, while that of group A at the last follow-up was 1.68 鹵3.96 擄and 1.95 鹵3.02 擄respectively. There was no significant difference between the correction kyphosis angle and the lost correction angle at the last follow-up. The average operation time of group A was 202.16 鹵53.20 min. The average hospitalization time of group A was 30.44 鹵9.30 days, the average hospitalization time of group B was 44.35 鹵13.53 days, and the mean time of operation in group B was significantly lower than that in group B. There was significant difference in hospitalization time between two groups (P 0.05). The average intraoperative blood loss in group A was 712.40 鹵419.34 ml / h, in group B 951.92 鹵799.69 ml. There was no significant difference between the two groups. The mean preoperative ESR was 60.76 鹵20.19 mm / h in group A, the mean erythrocyte sedimentation rate was 45.28 鹵17.68 mm / h at one week after operation, and the mean preoperative ESR in group B was 29.72 鹵16.97mm / h at 3 months after operation. The mean ESR was 53.69 鹵31.69mm / h, 37.00 鹵25.52mm / h at 1 week postoperatively and 24.54 鹵17.32mm / h at 3 months postoperatively. There was no significant difference in ESR between 1 week after operation and March after operation (P 0.05). ESR was significantly improved at 1 week and 3 months after operation. The difference was statistically significant (P 0.05). Conclusion it is safe and feasible to implant titanium cage filled with autologous granular bone for fusion fixation of thoracolumbar tuberculosis after one stage posterior debridement. Compared with iliac bone graft fusion, one stage posterior debridement with titanium cage fusion and internal fixation can effectively reduce the operation time and shorten the hospitalization time. Complications such as iliac pain, hematoma and other complications could be avoided after operation. However, there was no significant difference in the loss of correction angle and fusion time in the long term follow-up. There was no significant difference in the removal of posterior tuberculous foci. Titanium cage bone graft fusion and internal fixation were used to treat spinal tuberculosis. Postoperative correction of thoracolumbar tuberculosis kyphosis deformity and immediate stability can be achieved, the clinical efficacy is obvious, the long-term effect needs to be further observed.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

【參考文獻】

相關期刊論文 前9條

1 王鵬翔;趙劍;趙敦炎;施紅光;顧德林;張?zhí)煲?;結核桿菌在不同內固定材料表面粘附情況的實驗研究[J];交通醫(yī)學;2007年01期

2 張衛(wèi);姚女兆;王文軍;李平原;;一期前路病灶清除內固定治療胸腰椎結核[J];中國醫(yī)學工程;2005年06期

3 周勁松,陳建庭,金大地,劉金標;結核分枝桿菌對材料粘附能力的體外實驗研究[J];中國脊柱脊髓雜志;2003年11期

4 王錫陽;魏偉強;李偉偉;李洪波;龐曉陽;周炳炎;;一期后路病灶清除植骨融合內固定治療胸腰椎結核[J];中國脊柱脊髓雜志;2009年11期

5 陳宣維;林建華;陳雷;陳飛;許衛(wèi)紅;韋超;;一期后路病灶清除植骨融合內固定治療胸椎結核[J];中國修復重建外科雜志;2011年10期

6 袁凱;陳建庭;;脊柱結核外科治療植骨材料的臨床應用與研究進展[J];中國矯形外科雜志;2012年21期

7 官眾;許勇;任磊;鮑建峰;;三種不同植骨方式在胸、腰椎結核手術治療中的觀察[J];中國脊柱脊髓雜志;2013年06期

8 秦世炳;;重視結核病診治和脊柱結核手術時機的選擇[J];中國骨傷;2013年07期

9 羊明智;彭立軍;胡文凱;;一期后路病灶清除植骨選擇性病椎置釘內固定術在相鄰多個胸腰椎結核中的應用[J];現(xiàn)代醫(yī)藥衛(wèi)生;2013年15期

，

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