2021 年第 9 期 第 16 卷

小切口前路病灶清除钛笼植骨内固定治疗胸腰椎结核的临床效果

Clinical effect of titanium cage bone graft and internal fixation with small incision anterior focus debridement on the treatment of thoracolumbar tuberculosis

作者：宋永财卫永鲲杨斌辉于洋杨立峰

英文作者：Song Yongcai Wei Yongkun Yang Binhui Yu Yang Yang Lifeng

单位：三二〇一医院创伤关节外科，陕西省汉中市723000

英文单位：Department of Traumatic Joint Surgery 3201 Hospital Shaanxi Province Hanzhong 723000 China

关键词：胸腰椎结核；小切口前路；病灶清除；钛笼植骨

英文关键词：Thoracolumbartuberculosis;Smallincisionanteriorfocus;Lesiondebridement;Titaniumcagebonegraft

• 摘要：

• 目的 观察小切口前路病灶清除钛笼植骨内固定治疗胸腰椎结核的临床效果。方法 回顾性分析2018年12月至2019年12月三二〇一医院收治的86例行小切口前路病灶清除的胸腰椎结核患者的资料。其中46例采用钛笼植骨及钛板内固定治疗（观察组），40例采用肋骨条捆绑放置或大块髂骨支撑植骨及钢板内固定治疗（对照组）。2组均随访6个月。对比2组手术时间、住院时间和术后3、6个月的骨性融合率，并比较术前和随访6个月后Cobb角、Frankel分级情况，另比较术前和术后3、6个月的C反应蛋白（CRP）、红细胞沉降率（ESR）水平以及并发症发生率。结果 观察组手术时间、住院时间均短于对照组，术后3、6个月的骨性融合率均高于对照组（均P<0.05）。随访6个月后，2组Cobb角均较手术前减小，且观察组小于对照组［（4.8±0.8）°比（5.4±0.9）°］，差异均有统计学意义（均P<0.01）。随访6个月后2组Frankel分级E级的比例均高于手术前（均P<0.05），且观察组E级的比例高于对照组［95.7%（44/46）比80.0%（32/40）］（χ2=5.101，P=0.024）。2组术后3、6个月的CRP、ESR水平均低于术前，且观察组均低于对照组，差异均有统计学意义（均P<0.05）。2组术后随访期间并发症发生率差异无统计学意义（P>0.05）。结论 小切口前路病灶清除钛笼植骨内固定治疗用于胸腰椎结核患者能够缩短手术时间、住院时间和骨性融合时间，可有效矫正脊柱后凸畸形，改善脊柱损伤与机体炎症状态，是一种安全、有效的治疗方法。

• Objective To observe the clinical effect titanium cage bone graft and internal fixation with small incision anterior focus debridement on treating thoracolumbar tuberculosis. Methods The data of 86 cases of thoracolumbar tuberculosis patients who underwent small incision anterior focus debridement in 3201 Hospital from December 2018 to December 2019 were retrospectively analyzed. Among them, 46 cases were treated with titanium cage bone graft and titanium plate internal fixation (observation group), and 40 cases were treated with rib strips placed in bundles or large iliac bone supports bone grafting and internal fixation with steel plate(control group). The two groups were followed-up for 6 months. The operation time, length of stay and bone fusion rate at 3 and 6 months after operation of the two groups were compared. The Cobb angle and Frankel classification before operation and 6 months after follow-up were compared between the two groups, and the levels of C-reactive protein(CRP) and erythrocyte sedimentation rate(ESR) before operation, 3 and 6 months after operation and complication rate were also compared. Results The operation time and length of stay in observation group were shorter than those in control group, and the bone fusion rates in observation group at 3 and 6 months after operation were higher than those in control group(all P<0.05). After 6 months of follow-up, the Cobb angle in both groups decreased, and that in observation group was lower than that in control group［（4.8±0.8）° vs （5.4±0.9）°］(all P<0.01). After 6 months of follow-up, the proportion of Frankel grade E in two groups were higher than that before operation (both P<0.05), and that in observation group was higher than that in control group［95.7%(44/46) vs 80.0%(32/40)］(χ2=5.101, P=0.024). The levels of CRP and ESR at 3 and 6 months after operation in both groups were lower than those before operation, and those in observation group were lower than those in control group(all P<0.05). There was no significant difference in the incidence of complications during the follow-up period between the two groups(P>0.05). Conclusions Titanium cage bone graft and internal fixation with small incision anterior focus debridement treatment for thoracolumbar tuberculosis patients can shorten the operation time, length of stay and bone fusion time. It can effectively correct kyphosis, and improve spinal injury and the inflammatory state of the body, which is a safe and effective treatment method.