中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (35): 6591-6595.doi: 10.3969/j.issn.1673-8225.2010.35.033

• 骨与关节学术探讨 academic discussion of the bone and joint • 上一篇    下一篇

不同植入体置入内固定在胸腰椎结核治疗中的应用

施向春   

  1. 贵州省黔南州人民医院骨二科，贵州省都匀市 558000
  • 出版日期:2010-08-27 发布日期:2010-08-27
  • 作者简介:施向春，男，1970年生，上海市人，汉族，1993年贵阳医学院毕业，副主任医师，主要从事创伤、脊柱骨病方面的研究。 SXC8886@163.com

Application of different internal fixation implants in treating thoracolumbar tuberculosis

Shi Xiang-chun   

  1. Second Department of Orthopedics, Qiannan People's Hospital, Qiannan  558000, Guizhou Province, China
  • Online:2010-08-27 Published:2010-08-27
  • About author:Shi Xiang-chun, Associate chief physician, Second Department of Orthopedics, Qiannan People's Hospital, Qiannan 558000, Guizhou Province, China SXC8886@163.com

PDF

595

被引次数

12

摘要：

目的：探讨一期病灶清除后前路或后路应用不同植入体内固定治疗胸腰椎结核的临床效果。
方法：以 “胸腰椎结核，内固定，钛网，自体骨，骨水泥，前后路”为中文关键词；以:“thoracolumbar spinal tuberculosis;internal fixation;titanium mesh;autogenous bone;cement;anterior and posterior” 为英文关键词，采用计算机检索2007-01/2010-05相关文章。纳入与一期病灶清除前路或后路内固定治疗胸腰椎结核的相关文章；排除重复研究或Meta分析类文章。以30篇文献为主重点探讨了不同植入体内固定治疗胸腰椎结核的临床效果。
结果：目前内固定材料均以钛合金为主，再加前或后路的植骨融合，是治疗胸腰椎结核的主要方法，其优点在于钛合金具有良好的组织相容性和耐腐蚀性，不易发生异物反应。而结核菌在金属表面形成的多糖膜相对薄弱，抗结核药物和患者自身免疫机理仍能够发挥作用，病灶处植入固定物引起感染扩散的可能性较小。但无论是哪种植入体都存在内固定材料长期摩擦刺激血管和内固定物松动、脱落等并发症。                

结论：随着内固定材料和内固定技术的发展，大量的临床应用已经证明脊柱结核患者使用内固定的安全性和有效性，而一期重建脊柱的稳定性是提高脊柱结核手术效果的重要因素之一。低磨损、高相容性的内固定植入体是提高治疗质量的重要因素，从而能够更好地延长假体使用寿命。

关键词: 胸腰椎结核, 内固定, 钛网, 自体骨, 骨水泥, 前后路

Abstract:

OBJECTIVE: To explore the clinical effect of anterior or posterior internal fixation following focus debridement on thoracolumbar tuberculosis.
METHODS: A computer-based online search was performed with the key words “thoracolumbar spinal tuberculosis; internal fixation; titanium mesh; autogenous bone; cement; anterior and posterior” in Chinese and English, respectively for articles published from January 2007 to May 2010. Meta analysis or repetitive studies were excluded. A total of 30 articles were included to discuss the clinical outcomes of different implant internal fixations for thoracolumbar tuberculosis.
RESULTS: Titanium alloy as internal fixation materials plus anterior or posterior bone grafting fusion has become main method for treating thoracolumbar tuberculosis. It has advantages that titanium alloy has histocompatibility and corrosivity resistance. Pyrenomycetes formed poloysaccharide on metal surface is relatively few and antituberculosis drugs and patient autoimmunity are effective, therefore, implant-induced infection rate is low. However, long-term implantation of implants for internal fixation stimulates blood vessels and induces fixtor loosening or shedding.
CONCLUSION: With developing internal fixation materials, increasing clinical applications have demonstrated the safety and efficacy of internal fixation in spinal tuberculosis patients. Moreover, reconstruction of spinal stability is important to improve operation efficacy. Internal fixator with low wearing but high compatibility can significantly improve treatment and prolong prosthesis lifespan.

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