不同結(jié)構(gòu)性植骨材料在胸腰椎結(jié)核治療中療效的回顧性對比研究
發(fā)布時間：2019-07-01 08:37
【摘要】：背景:近年來,骨關節(jié)結(jié)核的發(fā)病率呈上升趨勢,其中脊柱結(jié)核占全身骨關節(jié)結(jié)核的50%左右,而胸腰椎結(jié)核是脊柱結(jié)核的好發(fā)部位。胸腰椎結(jié)核可造成患者嚴重畸形、神經(jīng)功能障礙,甚至全癱,嚴重影響著人們的健康。目前多數(shù)較輕微的結(jié)核可以通過保守治療治愈,但是對于嚴重結(jié)核,在使用抗結(jié)核藥物化療的的同時仍需要手術治療來促進結(jié)核愈合,重建脊柱穩(wěn)定性,減少傷殘,避免和治療各種并發(fā)癥,提高脊柱結(jié)核患者的生活質(zhì)量。目的:本課題旨在通過回顧性研究比較不同植骨方式治療單節(jié)段及跨節(jié)段胸腰椎結(jié)核的手術效果,探討鈦網(wǎng)、自體髂骨塊、同種異體骨及椎間融合器四種植骨方式在治療胸腰椎結(jié)核中的臨床療效。為臨床醫(yī)生在脊柱結(jié)核患者徹底病灶清除后選擇何種植骨技術和結(jié)構(gòu)性植骨材料提供臨床依據(jù)。研究對象與方法:1.回顧性分析我院2005年1月至2013年5月收治的單節(jié)段胸腰椎結(jié)核患者。研究對象:在抗結(jié)核治療基礎上采用前路或后路徹底病灶清除、植骨融合內(nèi)固定術治療且有24個月以上隨訪記錄的患者。分組:鈦網(wǎng)組(A組)29例;自體髂骨塊組(B組)32例;同種異體骨組(C組)25例;椎間融合器組(D組)26例。臨床療效評價指標:①美國脊髓損傷協(xié)會(ASIA)評分分級;②術前、術后后凸畸形角度(Cobb’s角)及末次隨訪時丟失的Cobb’s角;③植骨融合率,植骨融合情況,采用Bridwell評價標準;④手術的時間;⑤術中出血量;⑥住院的時間;⑦術后引流量;⑧并發(fā)癥。隨訪方式:通過門診、電話及信件等方式進行隨訪。比較方式:組內(nèi)術前與術后隨訪時間段對比,組間同一時間段對比。2.回顧性分析我院2005年1月至2013年5月收治的跨節(jié)段胸腰椎結(jié)核患者。研究對象:在抗結(jié)核治療基礎上采用前路或后路徹底病灶清除、植骨融合內(nèi)固定術治療且有24個月以上隨訪記錄的患者。分組:鈦網(wǎng)組(a組)30例;自體髂骨塊組(b組)27例;同種異體骨組(c組)25例。臨床療效評價指標:①美國脊髓損傷協(xié)會(asia)評分分級;②術前、術后后凸畸形角度(cobb’s角)及末次隨訪時丟失的cobb’s角;③植骨融合率,植骨融合情況,采用bridwell評價標準;④手術的時間;⑤術中出血量;⑥住院時間;⑦術后的引流量;⑧并發(fā)癥。隨訪方式:通過門診、電話及信件等方式進行隨訪。比較方式:組內(nèi)術前與術后隨訪時間段對比,組間同一時間段對比。結(jié)果:1、納入研究單節(jié)段病例有112例,隨訪24~67個月,平均43.6個月。四組結(jié)核患者在手術后的神經(jīng)功能與術前相比均有改善,但各組之間比較沒有顯著性差異(p0.05)。四組患者手術后的后凸角度均有明顯改善(p0.05),四組之間比較沒有顯著性差異(p0.05),在末次隨訪時各組患者cobb角丟失度比較差異無顯著性(p0.05)。a、b組12月植骨融合率比較差異無顯著性(p0.05),a、c、d組比較差異具有顯著性(p0.05),a組高于c、d組。b組患者的手術時間、術中出血量均多于a、c、d組,具有顯著性差異(p0.05);a、c、d組手術時間、術中出血量比較,差異無顯著性(p0.05);四組患者術后引流量及住院時間比較差異無顯著性(p0.05)。四組間比較并發(fā)癥率無統(tǒng)計學差異(p0.05)。末次隨訪時各組均融合,無植骨材料及內(nèi)固定的松動或移位。2、納入研究跨節(jié)段病例有82例,隨訪24~72個月,平均45.5個月。三組結(jié)核患者術后的神經(jīng)功能較手術前均有改善,但組間沒有顯著性差異(p0.05)。三組結(jié)核患者術后的后凸角度均有明顯改善(p0.05),三組之間比較沒有顯著性差異(p0.05),患者的末次隨訪時各組患者cobb角丟失度比較差異無顯著性(p0.05)。a、b組植骨融合率比較差異無顯著性(p0.05),a、c組比較差異具有顯著性(p0.05),a組高于c組。b組結(jié)核患者手術時間、術中出血量均多于a、c組,差異具有顯著性(p0.05);a、c組手術時間、術中出血量比較,差異無顯著性(p0.05);三組患者術后引流量及住院時間比較差異無顯著性(p0.05)。三組間比較并發(fā)癥率無統(tǒng)計學差異(p0.05)。末次隨訪時各組均融合,無植骨材料及內(nèi)固定的松動或移位。結(jié)論:1、本研究中不同結(jié)構(gòu)性植骨材料在單節(jié)段、跨節(jié)段胸腰椎結(jié)核治療中均可獲得良好的臨床療效。2、單節(jié)段胸腰椎結(jié)核治療中,鈦網(wǎng)植骨較自體髂骨塊植骨,植骨融合率相當,但可以有效縮短手術時間、減少術中出血量;鈦網(wǎng)植骨較同種異體骨植骨及Cage植骨,手術時間、術中出血量沒有顯著差異,但植骨融合率更高。3、跨節(jié)段胸腰椎結(jié)核治療中,鈦網(wǎng)植骨較自體髂骨塊植骨,植骨融合率相當,但可以有效縮短手術時間、減少術中出血量;鈦網(wǎng)植骨較同種異體骨植骨,手術時間、術中出血量沒有顯著差異,但植骨融合率更高。4、鈦網(wǎng)是胸腰椎結(jié)核植骨的理想材料,鈦網(wǎng)植骨是治療胸腰椎結(jié)核的一種安全有效的方法。
[Abstract]:BACKGROUND: In recent years, the incidence of bone and joint tuberculosis is on the rise, among which, the spinal tuberculosis accounts for about 50% of the total body and bone joint tuberculosis, and the thoracic and lumbar tuberculosis is a good part of the spinal tuberculosis. The thoracic and lumbar tuberculosis can cause serious deformity, neurological disorder and even total paralysis of the patient, which seriously affects people's health. At present, most of the minor tuberculosis can be cured by conservative treatment, but for severe tuberculosis, the operation treatment is required to promote the healing of the tuberculosis, the reconstruction of the stability of the spine, the reduction of the disability, the avoidance and the treatment of various complications, And the quality of life of patients with spinal tuberculosis is improved. Objective: To study the effect of different bone grafting methods on the treatment of thoracolumbar spinal tuberculosis with different bone graft methods, and to explore the clinical effect of titanium mesh, autograft bone mass, allogenic bone and interspinous process in the treatment of thoracic and lumbar tuberculosis. To provide a clinical basis for the selection of bone and structural bone graft materials for clinical doctors after thorough debridement of the patients with spinal tuberculosis. Research object and method:1. The patients of thoracolumbar tuberculosis from January 2005 to May 2013 were analyzed retrospectively. Study object: The patients who were treated with anterior or posterior complete lesion removal, bone graft fusion and internal fixation with 24-month follow-up were used on the basis of anti-tuberculosis treatment. Group:29 cases of titanium net group (group A),32 cases of autograft group (group B),25 cases of allogenic bone group (group C),26 cases of intervertebral fusion group (D group). The evaluation index of clinical curative effect: the classification of the American Spinal Cord Injury Association (AIA); the angle of the post-operative kyphosis (Cobb's angle) and the lost Cobb's angle at the last follow-up; the fusion rate of the implant and the fusion of the bone graft; the Bridwell evaluation standard; the time of the orthopedic operation; Keywords Intraoperative hemorrhagic volume; hospitalization time; post-operative drainage; complications. Follow-up: follow-up through out-patient, telephone and letter. Comparison method: compared with the follow-up period before and after the intra-operative procedure, the same time period was compared between the groups. A retrospective analysis of patients with transthoracic and lumbar tuberculosis from January 2005 to May 2013 was analyzed retrospectively. Study object: The patients who were treated with anterior or posterior complete lesion removal, bone graft fusion and internal fixation with 24-month follow-up were used on the basis of anti-tuberculosis treatment. Group:30 cases of titanium net group (group a),27 cases of autogenous bone block group (b group),25 cases of allogenic bone group (c group). The evaluation index of clinical curative effect: the score of the spinal cord injury association (asia) in the United States; the angle of the post-operative kyphosis (the angle of the cob's) and the loss of the cob's angle at the last follow-up; the fusion rate of the implant and the fusion of the bone graft, using the Bridwell evaluation standard; the time of the orthopedic operation; Keywords Intraoperative hemorrhagic volume; hospitalization time; post-operative drainage; complications. Follow-up: follow-up through out-patient, telephone and letter. Comparison method: compared with the follow-up period before and after the intra-operative procedure, the same time period was compared between the groups. Results:1.112 cases were included in the single section of the study, followed up for 24 to 67 months, with an average of 43.6 months. The neurological function of four groups was improved after operation, but there was no significant difference between the groups (p0.05). There was no significant difference between the four groups (p0.05), and there was no significant difference between the four groups (p0.05). The difference of group d in group d was significant (p0.05), and group a was higher than that of c and d. The operative time of group b and the amount of intraoperative blood loss were more than a, c and d, and there was a significant difference (p0.05), and the operative time of group a, c and d and the amount of intraoperative blood loss were not significant (p0.05). There was no significant difference between the post-operative drainage and the hospital stay in the four groups (p0.05). There was no statistical difference between the four groups (p0.05). At the last follow-up, all groups were fused, and there was no loose or dislodgment of bone graft material and internal fixation. There were 82 cases of cross-section in the study, followed up for 24 to 72 months, with an average of 45.5 months. The neurological function of the three groups was improved after operation, but there was no significant difference between the groups (p0.05). There was no significant difference between the three groups (p0.05), and there was no significant difference between the three groups (p0.05). There was significant difference in group c (p0.05), and group a was higher than that in group c. There was no significant difference (p0.05) between the operation time of the group B and the amount of blood loss during the operation, and the difference between the operation time of the group a and c and the amount of blood loss during the operation was not significant (p0.05), and there was no significant difference between the postoperative drainage and the hospitalization time in the three groups (p0.05). There was no statistical difference between the three groups (p0.05). All groups were fused at the last follow-up, and there was no loosening or displacement of the bone graft material and the internal fixation. Conclusion:1. Different structural bone graft materials in this study can achieve good clinical curative effect in the treatment of single-section and cross-section thoracolumbar tuberculosis. But the operation time can be effectively shortened, the intraoperative blood loss is reduced, the titanium mesh bone grafting is more than the allograft bone grafting and the Cage bone grafting, the operation time and the intraoperative blood loss are not significantly different, but the fusion rate of the bone grafting is higher. The fusion rate of the bone graft is equivalent, but the operation time can be effectively shortened, the intraoperative blood loss is reduced, the titanium mesh bone graft is more than the allograft bone graft, the operation time and the intraoperative blood loss are not significantly different, but the fusion rate of the bone grafting is higher. Titanium mesh bone graft is a safe and effective method for treating thoracic and lumbar tuberculosis.
【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
[Abstract]:BACKGROUND: In recent years, the incidence of bone and joint tuberculosis is on the rise, among which, the spinal tuberculosis accounts for about 50% of the total body and bone joint tuberculosis, and the thoracic and lumbar tuberculosis is a good part of the spinal tuberculosis. The thoracic and lumbar tuberculosis can cause serious deformity, neurological disorder and even total paralysis of the patient, which seriously affects people's health. At present, most of the minor tuberculosis can be cured by conservative treatment, but for severe tuberculosis, the operation treatment is required to promote the healing of the tuberculosis, the reconstruction of the stability of the spine, the reduction of the disability, the avoidance and the treatment of various complications, And the quality of life of patients with spinal tuberculosis is improved. Objective: To study the effect of different bone grafting methods on the treatment of thoracolumbar spinal tuberculosis with different bone graft methods, and to explore the clinical effect of titanium mesh, autograft bone mass, allogenic bone and interspinous process in the treatment of thoracic and lumbar tuberculosis. To provide a clinical basis for the selection of bone and structural bone graft materials for clinical doctors after thorough debridement of the patients with spinal tuberculosis. Research object and method:1. The patients of thoracolumbar tuberculosis from January 2005 to May 2013 were analyzed retrospectively. Study object: The patients who were treated with anterior or posterior complete lesion removal, bone graft fusion and internal fixation with 24-month follow-up were used on the basis of anti-tuberculosis treatment. Group:29 cases of titanium net group (group A),32 cases of autograft group (group B),25 cases of allogenic bone group (group C),26 cases of intervertebral fusion group (D group). The evaluation index of clinical curative effect: the classification of the American Spinal Cord Injury Association (AIA); the angle of the post-operative kyphosis (Cobb's angle) and the lost Cobb's angle at the last follow-up; the fusion rate of the implant and the fusion of the bone graft; the Bridwell evaluation standard; the time of the orthopedic operation; Keywords Intraoperative hemorrhagic volume; hospitalization time; post-operative drainage; complications. Follow-up: follow-up through out-patient, telephone and letter. Comparison method: compared with the follow-up period before and after the intra-operative procedure, the same time period was compared between the groups. A retrospective analysis of patients with transthoracic and lumbar tuberculosis from January 2005 to May 2013 was analyzed retrospectively. Study object: The patients who were treated with anterior or posterior complete lesion removal, bone graft fusion and internal fixation with 24-month follow-up were used on the basis of anti-tuberculosis treatment. Group:30 cases of titanium net group (group a),27 cases of autogenous bone block group (b group),25 cases of allogenic bone group (c group). The evaluation index of clinical curative effect: the score of the spinal cord injury association (asia) in the United States; the angle of the post-operative kyphosis (the angle of the cob's) and the loss of the cob's angle at the last follow-up; the fusion rate of the implant and the fusion of the bone graft, using the Bridwell evaluation standard; the time of the orthopedic operation; Keywords Intraoperative hemorrhagic volume; hospitalization time; post-operative drainage; complications. Follow-up: follow-up through out-patient, telephone and letter. Comparison method: compared with the follow-up period before and after the intra-operative procedure, the same time period was compared between the groups. Results:1.112 cases were included in the single section of the study, followed up for 24 to 67 months, with an average of 43.6 months. The neurological function of four groups was improved after operation, but there was no significant difference between the groups (p0.05). There was no significant difference between the four groups (p0.05), and there was no significant difference between the four groups (p0.05). The difference of group d in group d was significant (p0.05), and group a was higher than that of c and d. The operative time of group b and the amount of intraoperative blood loss were more than a, c and d, and there was a significant difference (p0.05), and the operative time of group a, c and d and the amount of intraoperative blood loss were not significant (p0.05). There was no significant difference between the post-operative drainage and the hospital stay in the four groups (p0.05). There was no statistical difference between the four groups (p0.05). At the last follow-up, all groups were fused, and there was no loose or dislodgment of bone graft material and internal fixation. There were 82 cases of cross-section in the study, followed up for 24 to 72 months, with an average of 45.5 months. The neurological function of the three groups was improved after operation, but there was no significant difference between the groups (p0.05). There was no significant difference between the three groups (p0.05), and there was no significant difference between the three groups (p0.05). There was significant difference in group c (p0.05), and group a was higher than that in group c. There was no significant difference (p0.05) between the operation time of the group B and the amount of blood loss during the operation, and the difference between the operation time of the group a and c and the amount of blood loss during the operation was not significant (p0.05), and there was no significant difference between the postoperative drainage and the hospitalization time in the three groups (p0.05). There was no statistical difference between the three groups (p0.05). All groups were fused at the last follow-up, and there was no loosening or displacement of the bone graft material and the internal fixation. Conclusion:1. Different structural bone graft materials in this study can achieve good clinical curative effect in the treatment of single-section and cross-section thoracolumbar tuberculosis. But the operation time can be effectively shortened, the intraoperative blood loss is reduced, the titanium mesh bone grafting is more than the allograft bone grafting and the Cage bone grafting, the operation time and the intraoperative blood loss are not significantly different, but the fusion rate of the bone grafting is higher. The fusion rate of the bone graft is equivalent, but the operation time can be effectively shortened, the intraoperative blood loss is reduced, the titanium mesh bone graft is more than the allograft bone graft, the operation time and the intraoperative blood loss are not significantly different, but the fusion rate of the bone grafting is higher. Titanium mesh bone graft is a safe and effective method for treating thoracic and lumbar tuberculosis.
【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
【相似文獻】
相關期刊論文 前10條
1 盧成曉;王榮冠;王庚軍;趙杰;;側(cè)前路減壓植骨鋼板內(nèi)固定治療胸腰椎結(jié)核伴不全癱的體會[J];中原醫(yī)刊;2006年04期
2 馬春光;楊麗;;胸腰椎結(jié)核手術副損傷的防治[J];中國社區(qū)醫(yī)師(綜合版);2006年12期
3 張可成;蔣塔麗;伊力哈木;劉金林;;胸腰椎結(jié)核的手術治療[J];中醫(yī)正骨;2006年08期
4 劉炯;龍浩;肖杰;王積輝;陳洪強;;胸腰椎結(jié)核35例手術治療體會[J];貴州醫(yī)藥;2007年07期
5 王忠遠;閆飛;施向春;胡曉峰;陸庭永;李永碧;;胸腰椎結(jié)核22例手術治療體會[J];貴州醫(yī)藥;2007年11期
6 陳敢峰;簡紹鋒;;綜合治療胸腰椎結(jié)核臨床觀察[J];甘肅中醫(yī)學院學報;2008年06期
7 羅晉光;賴新平;李國慶;羅月蘭;羅利萍;;168例胸腰椎結(jié)核臨床治療分析[J];內(nèi)蒙古中醫(yī)藥;2008年09期
8 李大偉;馬遠征;薛海濱;馮孟明;;耐藥胸腰椎結(jié)核的外科治療[J];軍醫(yī)進修學院學報;2010年06期
9 胡章勇;劉曉林;牟風云;;胸腰椎結(jié)核32例臨床診治[J];重慶醫(yī)學;2010年13期
10 湯文衛(wèi);;胸腰椎結(jié)核臨床療效分析[J];中外醫(yī)療;2011年35期
相關會議論文 前10條
1 王杰;;胸腰椎結(jié)核的診斷(附39病例)[A];第十六屆全國中西醫(yī)結(jié)合骨傷科學術研討會暨中西醫(yī)結(jié)合手法治療骨傷科疾病新進展學習班論文匯編[C];2008年
2 滕曉;張招波;丁凌志;張景生;朱賢平;;后入路手術治療復發(fā)性胸腰椎結(jié)核的臨床研究[A];浙江省醫(yī)學會骨科學分會30年慶典暨2011年浙江省骨科學學術年會論文匯編[C];2011年
3 羅春山;李波;田曉濱;周焯家;彭智;簡月奎;趙偉峰;;多節(jié)段胸腰椎結(jié)核外科治療48例[A];貴州省中西醫(yī)結(jié)合學會骨傷分會第二次學術交流會議論文匯編[C];2011年
4 李松巍;張明;陳斌輝;張勇鵬;;前路病灶清除植骨固定治療胸腰椎結(jié)核臨床觀察[A];浙江省中西醫(yī)結(jié)合學會骨傷科專業(yè)委員會第十四次學術年會暨省級繼續(xù)教育學習班論文匯編[C];2008年
5 賀躍光;李公倫;孫杰;李旭東;張曉棠;張濤;歐陽海鷹;黃建黨;王國蕊;;前路鋼板加鈦網(wǎng)融合術治療胸腰椎結(jié)核的療效評價[A];第十九屆中國康協(xié)肢殘康復學術年會論文選集[C];2010年
6 賀躍光;李公倫;孫杰;李旭東;張濤;;前路鋼板加鈦網(wǎng)融合術治療胸腰椎結(jié)核的療效評價[A];第六屆西部骨科論壇暨貴州省骨科年會論文匯編[C];2010年
7 王p，
本文編號：2508334
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2508334.html
最近更新
教材專著
