摘要
目的:了解将异体冷冻干燥松质骨装填于钛网内,用于胸、腰椎结核手术前路支撑植骨,在完成脊柱重建和促进骨愈合方面的作用。方法:选择1999-01/2005-03解放军总医院骨科接受胸、腰椎结核病灶根治性清创,并采用冷冻干燥异体松质骨进行植骨融合的胸、腰椎结核患者24例进行信件和电话随访,其中19例患者完成随访。胸椎结核11例,腰椎结核8例。胸椎结核患者采用前方经胸腔入路或前方经胸膜外入路(用于T12的显露)进行病灶清除,钛网加异体骨植入,前路内固定。腰椎结核患者采用前方经腹膜后入路,钛网加异体骨植入,前路或前、后联合内固定。采用钛网菱形网格沉入终板的相对比值来表示钛网的沉降值,钛网菱形网格高度的测量值为9mm。分别测量钛网在头侧和尾侧终板上的沉降值。评估异体骨的融合情况:Ⅰ级为骨质融合,并有骨小梁影像;Ⅱ级为植骨完好,未见完全的骨质重塑和融合,但交界面没有透光区;Ⅲ级为植骨完好,但在移植骨的上、下端与受区骨的交界面处有透光区;Ⅳ级无任何骨融合迹象,移植骨吸收。结果:19例患者接受至少30个月的随访(30～73个月),平均随访51.2个月,随访率79.2%。①患者术后住院时间为6～26d(平均10.1d)。②最终随访患者的X射线片显示钛网在头侧终板的下沉为(0.60±0.06)个菱形网格高度,在尾侧终板的下沉为(0.40±0.06)个菱形网格高度,钛网平均总下沉高度为1.0个菱形网格高度,即绝对高度为9mm。③19例患者在末次随访时均观察到骨融合现象,X射线片显示在钛网旁可见骨桥形成,或者钛网两端与椎体的交界面模糊。胸椎骨融合Ⅰ级9例,Ⅱ级2例;腰椎骨融合Ⅰ级6例,Ⅱ级2例。结论:异体冷冻干燥松质骨装填入钛网或人工椎体可有效地应用于脊柱结核的前路椎体重建术,为了使植骨达到良好的再生和重塑,应进行稳固的内固定。
AIM： To investigate the ability of freeze-dried cancellous allograft, which was packed in a cylindrical mesh titanium cage, in reconstructing the anterior column and facilitating osseous fusion for thoracic and lumbar tuberculousis surgery. METHODS： There were 24 cases of thoracic and lumbar tuberculousis, who underwent radical debridement and freeze-dried cancellous allograft fusion between January 1999 and March 2005, were followed by mail and telephone. And 19 patients accepted the follow-up, which included 11 thoracic and 8 lumbar tuberculousis patients. The patients with thoracic tuberculousis underwent anterior transpleural and extrapleural （for T12） radical debridement, then the titanium mesh-allograft composite and anterior instrumentations were used for anterior spinal column reconstruction. For the lumbar tuberculousis patients, after retroperitoneal debridement, the titanium cage-allograft composite and anterior and /or posterior instrumentations were also used. Cage subsidence was measured in relation to the rhomboid-shaped fenestrations on the cages, each measuring 9mm in height, measuring the penetration in the cephalad and caudal endplates separately. The evaluation of osseous fusion was made as follows： Grade Ⅰ , fused with remodeling and trabeculae; Grade Ⅱ, graft intact,not fully remodeled and incorporated and no lucency; Grade Ⅲ, graft intact with potential lucency at the top or bottom of graft; and Grade Ⅳ, fusion absent with collapse or resorption of graft. RESULTS： Nineteen patients completed the follow-up for at least 30 months （30-73 month） with an average of 51.2 months, and the follow-up rate was 79.2%. ① The average in-hospital time was 6-26 days （mean 10.1 days）. ②At the final follow-up, the cage subsidence was measured to be an average of （0.60±0.06） rhomboid fenestrations at the cephalad endplate and （0.40±0.06） rhomboid-shaped cage fenestrations at the caudal endplate, with a range of 0-1.0 fenestrations of subsidence at each endplate. The total mean subsidence was 1.0 of the height of the cage fenestrations, or approximately 9 ram. ③Bone fusion was observed in all the 19 patients at the final follow-up. X-ray showed that the formation of bone bridge along the titanlum cage, and no lucency at the top or bottom of graft. Among the thoracic tuberculousis patients, 9 cases of Grade Ⅰ and 2 cases of Grade Ⅱ bone fusion were achieved; While 6 cases of Grade Ⅰ and 2 cases of Grade Ⅱ bone fusion were achieved among the lumbar tubereulousis patients.CONCLUSION： Freeze-dried cancellous bone is a liable graft material in spinal turberculosis arthrodesis. For the sake of allograft incorporation and remodeling, the rigid instrumentation should be achieved.
出处
《中国临床康复》
CSCD
北大核心
2006年第1期88-90,i0005,共4页
Chinese Journal of Clinical Rehabilitation
