Medical grade calcium sulfate bone incorporated with streptomycin in the treatment of thoracolumbar spinal tuberculosis

doi:10.3969/j.issn.2095-4344.2014.21.002

Abstract

Abstract:

BACKGROUND: Medical grade calcium sulfate bone for bone defects after removal of spinal tuberculosis is controversial; however, patients undergoing long-term intramuscular injection of streptomycin for anti-tuberculosis show a poor compliance, and local application can overcome these shortcomings.
OBJECTIVE: To study the clinical efficacy and outcome of medical grade calcium sulfate bone incorporated with streptomycin and autogenetic bone graft combined with posterior debridement and instrumentation for thoracolumbar spinal tuberculosis.
METHODS: From March 2008 to June 2012, 18 patients with thoracolumbar spinal tuberculosis were treated with one-stage posterior debridement, medical grade calcium sulfate bone incorporated with streptomycin and autogenetic bone graft and instrumentation on the basis of regular anti-tuberculosis. Incision healing, adverse reactions and the change of clinical symptoms were recorded. Bone fusion and deformity correction were analyzed by the regular X-ray examination.
RESULTS AND CONCLUSION: All the patients acquired satisfactory incision healing without obvious general adverse reactions. Clinical symptoms were differently relived. Kyphosis was corrected to some degree and the correction had no loss. Seventeen patients were cured after the first operation. Tuberculosis recurred in one patient 9 months after the first surgery and was cured after the second anterior surgery. X-ray examination showed that the calcium sulfate bone was clear 1 week after surgery and unclear 3 months after surgery. Bone fusion appeared 6 to 9 months after operation. These findings indicate that the application of medical grade calcium sulfate bone incorporated with streptomycin could achieve good effects in the treatment of thoracolumbar spinal tuberculosis, which is an excellent substitute material for bone graft. It not only could repair bone loss but also increase the concentration of anti-tuberculosis drugs.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: thoracic vertebrae, lumbar vertebrae, streptomycin, internal fixators

CLC Number:

R318

Chen Yong-zhong, Wang Jian-huo, Zhang Peng, Huang Zhe, Gong Yan-ding, Zhou Qing-bi . Medical grade calcium sulfate bone incorporated with streptomycin in the treatment of thoracolumbar spinal tuberculosis[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(21): 3287-3292.

Figures/Tables 3

2.2 含链霉素的医用硫酸钙人工骨与自体骨粒混合椎间植骨、椎弓根钉棒系统内固定治疗胸腰椎结核的疗效所有患者内固定中生命体征均平稳，手术顺利，内固定中未出现脊髓、神经、重要血管损伤、气胸、心脑血管意外等并发症。手术时间170-250 min，平均206 min；内固定中出血量为600-1 300 mL，平均出血量850 mL；内固定中输血400-800 mL，平均650 mL。内固定后患者恢复顺利，切口均一期愈合；内固定后常规病理均证实为结核。出院后随访9-18个月，平均13个月。所有患者均未出现耳鸣、听力下降等耳毒性症状，未发现肾损害；1例于内固定后9个月结核复发行前路手术后治愈，其余17例均一次手术治愈，腰背部疼痛及下肢放射痛完全缓解，下肢无力、感觉减退等神经功能受损获得不同程度的改善。内固定后1周复查胸腰椎X射线片提示后凸畸形获得不同程度的矫正，患者后凸Cobb角平均为(13.7±7.8)°，明显高于内固定前(P < 0.05)，硫酸钙人工骨颗粒显影清楚，内固定无松动等异常；内固定后3个月复查胸腰椎X射线片提示后凸畸形矫正无明显丢失，患者后凸Cobb角平均为(4.1±8.1)°，与内固定后1周差异无显著性意义(P > 0.05)，硫酸钙人工骨颗粒显影不清楚，内固定无松动、折断、脱出等异常；17例于内固定后6-9个月X射线片提示骨性愈合，1例结核复发再次手术内固定后6个月X射线片提示骨性愈合。 2.3 不良反应及生物相容性内固定后患者恢复顺利，切口均一期愈合，无耳鸣、耳聋等不良反应，内固定后肾功能检查未发现肾功能损害。含链霉素的医用硫酸钙人工骨植入体内后生物相容性良好。 2.4 典型病例患者，48岁，因“反复腰背部疼痛4年，加重伴活动受限2个月”入院，腰椎正侧位X射线片、CT及MRI检查诊断为腰椎结核(L3-L4)伴椎旁脓肿(图2A-E)。经四联抗结核治疗2周后行一期后路病灶清除、含链霉素硫酸钙人工骨与自体骨粒混合椎间植骨、椎弓根螺钉系统内固定，手术顺利，内固定后继续抗结核治疗，定期随访(图2F，G)。 3个月时患者腰背部疼痛完全缓解，无结核中毒症状，血沉正常，复查腰椎正侧位片示硫酸钙颗粒基本上已完全吸收，椎间隙模糊(图2H，I)。内固定后9个月腰椎正侧位X射线片显示L3/4间隙模糊，已骨性愈合(图3)。 "

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