Internal fixation with different bone grafts via pedicle approach for treatment of thoracic spinal tuberculosis

doi:10.3969/j.issn.2095-4344.2015.52.008

Abstract

Abstract:

BACKGROUND: Lots of bone graft materials such as autologous iliac bone, autologous rib, titanium mesh plus allograft are available in the treatment of bone defects after spinal tuberculosis debridement.
OBJECTIVE: To compare the fixation effect of different kinds of bone graft materials via pedicle approach fixation for treatment of thoracic spinal tuberculosis.
METHODS: Totally 40 patients with thoracic spinal tuberculosis were enrolled, including 18 patients accompanied with paraplegia and 15 patients accompanied with kyphosis deformity. Both of them were subjected to by standard anti-tuberculosis treatment for 2-4 weeks and consequent posterior pedicle screw fixation combined with debridement/bone grafting fusion. They were grouped by the variables of bone graft materials: autologous iliac bone, autologous rib, titanium mesh plus allograft groups. All patients were followed up for 24 months. The lesion healing, bone graft fusion, rehabilitation of paraplegia, correction of kyphosis and incidence of adverse reaction were observed.
RESULTS AND CONCLUSION: The time of bone graft fusion in the autologous iliac bone group was shorter than that in the autologous rib and titanium mesh plus allograft groups (P < 0.05), and there was no significant difference between autologous rib and titanium mesh plus allograft groups. No adverse phenomenons such as grafts and titanium mesh falling off, fracture and displacement, nonunion and pseudarthrosis, tuberculosis

recurrence were found in these three groups. After the symptomatic therapy for 3-6 months, the muscle strength of patients with paraplegia and spinal kyphosis deformity basically recovered, spinal kyphosis deformity was basically corrected. These results demonstrate that the treatment effect of autologous iliac bone is the best; however, the treatment effect of autologous rib is as good as the titanium mesh plus allograft.

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

CLC Number:

R318

Qiu Nan-hai, Wang Li, Yu Ming, Miao Rui-rui, Huang Bi-yu, Zhang Wen-long. Internal fixation with different bone grafts via pedicle approach for treatment of thoracic spinal tuberculosis[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(52): 8406-8411.

Figures/Tables 3

References

[1] Yusof MI,Hassan E,Rahmat N,et al.Spinal tuberculosis: the association between pedicle involvement and anterior column damage and kyphotic deformity.Spine (Phila Pa 1976).2009; 34(7):713-717.
[2] 马远征.关于脊柱结核病灶清除术的入路问题[J].中国脊柱脊髓杂志,2012,22(9):774.
[3] 彭明,戚超,曹新峰,等.胸腔镜辅助下前路一期病灶清除及植骨内固定术治疗胸椎结核[J].中国修复重建外科杂志,2010,24(11): 1405-1406.
[4] 周劲松,陈建庭,金大地,等.结核分枝杆菌对材料粘附能力的体外实验研究[J].中国脊柱脊髓杂志,2003,13(11):670-673.
[5] 杨海青,段洪,闵捷,等.钛网植骨结合椎弓根钉棒内固定修复胸椎结核:重建脊柱生理曲度及稳定性[J].中国组织工程研究,2014, 18(53):8590-8595.
[6] 张宏其.胸椎结核后入路手术的优点和适应证[J].中国脊柱脊髓杂志,2012,22(9):773-774.

[7] 崔旭,马远征,陈兴,等.胸椎结核治疗的术式选择: 81例分析[J].中华老年多器官疾病杂志,2012,11(10):755-760.
[8] 崔旭,马远征,陈兴,等.不同手术方法治疗脊柱结核及其疗效分析[J].中国脊柱脊髓杂志,2011,21(10):807-812．
[9] 朱定川,高峰,曾建成.胸椎结核经前路病灶清除融合单钉棒固定术的疗效观察[J].华西医学,2014,29(1):26-29.
[10] 张忠民,付忠泉,尹刚辉,等.胸椎结核外科治疗的长期临床随访[J].脊柱外科杂志,2012, 10(4):198-201.
[11] 姜传杰,杨永军,谭远超,等.一期后路病灶清除椎体钉内固定治疗中上胸椎结核[J].中国脊柱脊髓杂志,2010,20(4):326-330.
[12] 林宏,李康宁,向勇.胸腰椎结核伴截瘫的前路手术治疗[J].中国矫形外科志,2006,14(1):23-24.
[13] 徐大启,王锡阳,葛磊,等.后路经椎弓根病灶清除、自体及同种异体骨植骨融合并节段性内固定治疗胸腰椎结核[J].中国组织工程研究与临床康复,2009,13(22):4349-4354.
[14] 薛海滨,马远征,陈兴,等.不同术式治疗下腰椎结核的疗效分析[J].中国骨伤,2011, 24(5):394-398.
[15] Rawall S,Mohan K,Nene A.Posterior approach in thoracolumbar tuberculosis: a clinical and radiological review of 67 operated cases. Musculoskeletal surgery.2013; 97(1): 67-75.
[16] 刘勇,赵春成,高浩,等.经胸入路一期病灶清除植骨内固定治疗胸椎结核[J].中国脊柱脊髓杂志,2007,17(3):190-193.
[17] 张宏其,唐明星,葛磊,等.单纯经后路一期前方病灶清除、植骨内固定矫形治疗伴后凸畸形的高胸段脊柱结核[J].医学临床研究, 2008,25(11):1948-1951.
[18] Issack PS,Boachie-Adjei O.Surgical correction of kyphotic deformity in spinal tuberculosis. Int Orthop.2012;36(2): 353-357.
[19] 黄福立,张明友,刘永恒,等.一期侧前方入路病灶清除植骨融合内固定联合局部闭式冲洗引流治疗腰椎结核伴椎旁脓肿[J].中国脊柱脊髓杂志,2014,24(5):422-426.
[20] 李江龙,陈春,刘继波,等.经后路一期病灶清除、自体植骨融合、内固定治疗胸腰椎结核20例[J].重庆医学,2013,42(20): 2416-2418.
[21] 王亚平,王新春,熊才亮,等.经后路同一切口侧前方病灶清除植骨内固定术治疗胸椎结核[J].重庆医学,2013,42(30):3685-3686．
[22] 张宏其,邵宇雄,邓鸯,等.一期后路病灶清除椎间植骨内固定术治疗老年胸椎结核[J].中国矫形外科杂志,2011,19(13): 1089- 1092.
[23] 黄媛霞,徐海斌.脊柱结核内固定植入材料的临床应用及其生物相容性[J].中国组织工程研究与临床康复,2009,13(43): 8544- 8547.
[24] 张根民,王力刚.胸椎结核前、后入路手术分析[J].中国脊柱脊髓杂志,2004,14(1):44-46.
[25] 赵刚,陈朝伟,汪浩广,等.一期病灶清除椎间植骨内固定治疗脊柱结核[J].中国矫形外科杂志,2012,20(21):1987-1990.
[26] 罗一,邓展生,陈静,等.有限减压及椎板重建在单节段胸椎结核手术治疗中的应用[J].中国修复重建外科杂志,2012,26(12): 1409-1414.
[27] 谢超凡,刘少喻,梁春祥,等.单纯后路减压病灶清除内固定治疗伴神经损害的胸椎结核[J].脊柱外科杂志,2012,10(4):202-205.
[28] Wee JH,Lee CH,Rhee CS,et al.Comparison between Gelfoam packingand no packing after endoscopic sinus surgery in the same patients.Eur Arch Otorhinolaryngol. 2012;269(3): 897-903.
[29] Zhang H,Huang S,Guo H,et al.A clinical study of internal fi xation,debridement and interbody thoracic fusion to treat thoracic tuberculosisvia posterior approach only. Int Orthop. 2012;36(2):293-298.