中国组织工程研究

中国组织工程研究 ›› 2013, Vol. 17 ›› Issue (22): 4034-4041.doi: 10.3969/j.issn.2095-4344.2013.22.007

• 脊柱植入物 spinal implant • 上一篇    下一篇

钛网及植骨融合修复中重度脊柱后凸畸形

楚  戈1，张宏其1，唐明星1，郭超峰1，李劲松1，项泽文2，白靖平3   

  1. 1中南大学湘雅医院脊柱外科，湖南省长沙市  410008
    2新疆自治区中医医院脊柱一科，新疆维吾尔自治区乌鲁木齐市  830000
    3 新疆自治区肿瘤医院骨科，新疆维吾尔自治区乌鲁木齐市  830000
  • 出版日期:2013-05-28 发布日期:2013-05-28
  • 通讯作者: 张宏其，博士，主任医师，博士生导师，教授，中南大学湘雅医院脊柱外科，湖南省长沙市 410008
  • 作者简介:楚戈☆，男，1976年生，河北省保定市人，汉族，中南大学湘雅医院脊柱外科在读博士，主治医师，主要从事脊柱外科基础和临床研究工作。 Xiaochu138@sina.com

Titanium mesh and interbody fusion repair medium and severe kyphosis deformity

Chu Ge1, Zhang Hong-qi1, Tang Ming-xing1, Guo Chao-feng1, Li Jin-song1, Xiang Ze-wen2,Bai Jing-ping3   

  1. 1 Department of Spine Surgery, Xiangya Hospital of Central South University, Changsha  410008, Hunan Province, China
    2 First Department of Spine Surgery, Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Urumqi  830000, Xinjiang Uygur Autonomous Region, China
    3 Department of Orthopedics, Cancer Hospital of Xinjiang Uygur Autonomous Region, Urumqi  830000, Xinjiang Uygur Autonomous Region, China
  • Online:2013-05-28 Published:2013-05-28
  • Contact: Zhang Hong-qi, M.D., Chief physician, Doctoral supervisor, Department of Spine Surgery, Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
  • About author:Chu Ge☆, Studying for doctorate, Attending physician, Department of Spine Surgery, Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China Xiaochu138@sina.com

PDF

382

被引次数

3

摘要：

背景：有学者提出的经前路矫正脊柱结核后凸畸形和解除脊髓压迫的治疗方法，可能会有植骨块塌陷、吸收或断裂的并发症。研究证实，通过一期前后路联合内固定可增加对后凸畸形的矫正力量，避免出现植骨并发症、降低假关节的形成并有助于患者早期下地活动及功能恢复。
目的：分析评价2个或多个节段受累伴中重度后凸畸形的脊柱结核患者，一期行前后路病灶清除、植骨融合内固定矫正后凸畸形的临床疗效。
方法：回顾性分析20例脊柱胸腰段有2个或更多节段受累的结核患者，一期行后路内固定融合并前路病灶清除钛网融合内固定。所有患者内固定后持续9个月抗结核化疗，最初3个月采用四联抗结核药物，后6个月采用三联抗结核药物。随访时测量后凸角度，评价患者融合情况、神经病变和功能恢复状况。
结果与结论：所有患者随访均超过37个月。所有患者均获得牢固节段融合重返工作岗位。内固定治疗后15例(75%)的患者仅残留局部轻度疼痛，3例(15%)活动受限明显。内固定前11例有神经功能障碍，内固定后9例神经功能完全恢复正常。后凸角度平均矫正了35.1°(84.8%)(P < 0.001)，在随访期间矫正丢失差异无显著性意义(P > 0.05)，未出现内固定及植骨相应并发症。结果表明，对于2个或更多节段受累伴有中重度后凸畸形的脊柱结核患者，应环形融合，即一期前后路联合内固定融合治疗。可获得更大矫正，有助于患者早期下地活动，稳定病变节段，而且可以长期有效地维持矫正效果。

关键词: 骨关节植入物, 脊柱植入物, 脊柱病变, 胸腰段, 内固定, 钛网, 一期前后路, 脊柱结核, 后凸畸形, 植骨融合, 神经功能, 后凸角, 植入物

Abstract:

BACKGROUND: Scholars have supposed that the treatment of spinal tuberculosis kyphosis with anterior approach and spinal cord decompression may lead to complications such as bone graft collapse, absorption or fracture. Studies have confirmed that one-stage anterior-posterior surgery combined with internal fixation can enhance the corrective effect to kyphosis, avoid bone graft complications, reduce the formation of false joints, help patients with early activities out of bed and promote the functional recovery.
OBJECTIVE: To evaluate the clinical outcome for tuberculous spondylitis of thoracolumbar region with two or more affected segments treated with one-stage anterior-posterior debridement, interbody fusion and internal fixation.
METHODS: We retrospectively studied 20 cases of tuberculous spondylitis of thoracolumbar region with two or more levels of involvement. All the patients underwent one-stage posterior fixation fusion and anterior debridement and titanium mesh fusion and internal fixation. All the patients received antituberculosis chemotherapy for 9 months after internal fixation. For the first 3 months, the patients were treated with quadruple antituberculosis drugs, and then treated with triple antituberculosis drugs in the later 6 months. The kyphosis angles were measured during follow-up to evaluate the fusion status, neuropathy and functional recovery.
RESULTS AND CONCLUSION: All the patients were followed-up for more than 37 months. All patients returned to their previous occupation after firmly segment fusion; only 15 cases (75%) felt mild pain or no pain and three cases (15%) with major limitations in activities. There were 11 patients with neurological deficit before internal fixation, and nine cases of these achieved complete neurological recovery. The kyphosis angles were corrected for 35.1° (84.8%) in average (P < 0.001), and there was no significant difference in correction loss during the follow-up period (P < 0.05). There were no grafts or fixation-related complications. Tuberculous spondylitis with involvements at two or more levels accompanied by medium and severe kyphosis should be treated with circumferential fusion, that is one-stage anterior-posterior fusion and fixation, which can obtain greater correction, help the patients with early activities out of bed, stabilize the lesioned segments, and long-term maintain the correction effect.

Key words: bone and joint implants, spinal implants, spinal lesions, thoracolumbar, internal fixation, titanium mesh, one-stage anterior-posterior approach, spinal tuberculosis, kyphosis, interbody fusion, neurological function, kyphosis angle, implants

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