發(fā)布時(shí)間：2018-03-03 03:17

  本文選題：胸腰椎結(jié)核　切入點(diǎn)：鈦籠植骨　出處：《福建醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)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(nèi)固定治療胸腰椎結(jié)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(xué)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(nèi)固定治療的51例胸腰椎結(jié)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(shù)時(shí)間、出血量、手術(shù)前后脊髓神經(jīng)功能Frankel分級(jí),炎癥指標(biāo)ESR,手術(shù)前后局部后凸畸形Cobb角矯正情況、植骨融合時(shí)間等,并進(jìn)行分析比較。結(jié)果:所有患者術(shù)后病理檢查均證實(shí)為結(jié)核病變,隨訪時(shí)間6-30月,隨訪期內(nèi)所有患者均達(dá)到骨性融合。A組術(shù)后1例患者出現(xiàn)病灶復(fù)發(fā),B組無出現(xiàn)結(jié)核病灶復(fù)發(fā),但有2例出現(xiàn)髂骨取骨區(qū)血腫、傷口愈合欠佳。術(shù)后無內(nèi)固定物斷裂、假關(guān)節(jié)形成等并發(fā)癥,植骨達(dá)骨性融合時(shí)間A組6-12個(gè)月,平均8.00±2.14個(gè)月,B組5-12個(gè)月,平均6.92±1.85個(gè)月,二者差異無統(tǒng)計(jì)學(xué)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(jīng)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(jì)學(xué)意義(P0.05)。A組平均手術(shù)時(shí)間202.16±53.20min,B組282.27±65.26min,A組平均住院時(shí)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(shù)時(shí)間、住院時(shí)間上差異有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)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(jì)學(xué)意義(P0.05)。A組術(shù)前血沉平均60.76±20.19mm/h,術(shù)后1周血沉平均45.28±17.68mm/h,術(shù)后3個(gè)月血沉平均29.72±16.97mm/h,B組術(shù)前血沉平均53.69±31.69mm/h,術(shù)后1周血沉平均37.00±25.52mm/h,術(shù)后3個(gè)月血沉平均24.54±17.32mm/h,兩組在術(shù)前、術(shù)后1周、術(shù)后3月的時(shí)間點(diǎn)上ESR差異無統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后1周、術(shù)后3個(gè)月ESR較術(shù)前有明顯改善,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:(1)胸腰椎結(jié)核行一期后路病灶清除后置入填充自體顆粒骨的鈦籠進(jìn)行植骨融合內(nèi)固定是安全可行的,其臨床療效對(duì)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(nèi)固定術(shù)可有效減少手術(shù)時(shí)間,縮短患者住院時(shí)間,同時(shí)可避免術(shù)后出現(xiàn)髂骨區(qū)疼痛、血腫等并發(fā)癥,而遠(yuǎn)期隨訪矯正角度的丟失及融合時(shí)間無顯著差別。(3)一期后路結(jié)核病灶清除應(yīng)用鈦籠植骨融合內(nèi)固定治療脊柱結(jié)核,術(shù)后可有效矯正胸腰椎結(jié)核后凸畸形且可獲得即刻的穩(wěn)定性,臨床療效明顯,長(zhǎng)期療效有待進(jìn)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(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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