关键词: 骨, 材料, 人工骨, 内固定, 结核, 椎间孔镜, 经皮钉, 腰椎结核

Abstract: BACKGROUND: Animal model experiments on bone tuberculosis showed that calcium sulfate artificial bone loading could slowly and permanently release anti-tuberculosis drugs, increase local drug concentration, and repair local bone defects and promote bone fusion.
OBJECTIVE: To evaluate the safety and efficacy of implantation of artificial bone with streptomycin sulfate and posterior percutaneous pedicle screw in the treatment of lumbar tuberculosis under transforaminal endoscopy after removal of lesions.
METHODS: Twenty-eight patients with lumbar spinal tuberculosis who were treated in the First Affiliated Hospital of Guangxi University of Chinese Medicine from July 2016 to June 2019 were selected, including 10 males and 18 females, at the age of 36-69 years. Twelve patients in the experimental group received implantation of artificial bone with streptomycin sulfate and posterior percutaneous pedicle screw under transforaminal endoscopy after removal of lesions. Sixteen patients in the control group received bone graft fusion and internal fixation under anterior and posterior combined approach or bone graft fusion and internal fixation after posterior approach. Operation time, intraoperative blood loss, and hospital stay were recorded. At 3 months postoperatively and at the last follow-up, erythrocyte precipitation, C-reactive protein level and Cobb angle, visual analogue scale score, lumbar Japanese Orthopaedic Association score and Oswestry disability index score were compared between the two groups. The experiment was approved by the Ethics Committee of First Affiliated Hospital of Guangxi University of Chinese Medicine. 
RESULTS AND CONCLUSION: (1) The operation time, intraoperative blood loss and hospital stay in the experimental group were all less than those in the control group (P < 0.05). (2) The erythrocyte sedimentation rate and C-reactive protein levels at 3 months after surgery and at the last follow-up in both groups were lower than those before surgery (P < 0.05), while those in the experimental group were lower than those in the control group (P < 0.05). (3) Visual analogue scale scores and Oswestry disability index scores of both groups were lower 3 months after surgery and at the last follow-up than those before surgery (P < 0.05), and lumbar  Japanese Orthopaedic Association score was higher than that before surgery (P < 0.05). The visual analogue scale score of the experimental group 3 months after operation was lower than that of the control group (P < 0.05). (4) Postoperative Cobb angle was lost in both groups, and there was no significant difference between the two groups (P > 0.05). (5) The results show that compared with the traditional posterior approach and combined anterior and posterior approaches in the treatment of lumbar tuberculosis, posterior lateral foramen endoscopic implantation of artificial bone with streptomycin sulfate combined with posterior percutaneous pedicle screw fixation can also achieve satisfactory clinical effect, and has the advantages of small trauma and rapid recovery. 

Key words: bone, material, artificial bone, internal fixation, tuberculosis, transforaminal endoscopy, percutaneous screw, lumbar spinal tuberculosis