Comparison between titanium mesh and autogenous iliac bone graft to restore vertebral height through posterior approach for the treatment of thoracic and lumbar spinal tuberculosis.
Comparison between titanium mesh and autogenous iliac bone graft to restore vertebral height through posterior approach for the treatment of thoracic and lumbar spinal tuberculosis.
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DOI：
10.1371/journal.pone.0175567
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Li J
中科院分区：
文献类型：
--
作者：
Gao Y;Ou Y;Deng Q;He B;Du X;Li J
比较钛网融合器与自体髂骨移植后路手术恢复椎体高度对胸腰椎结核患者的临床疗效。 2011年1月至2013年12月，我科对59例脊柱结核患者行后路椎间融合内固定术。A组34例采用钛网重建椎体高度，其中单节段脊柱结核25例（A1组），多节段脊柱结核9例（A2组）。 B组25例患者行自体髂骨移植恢复椎体高度，其中单节段脊柱结核24例（B1组），多节段脊柱结核1例（B2组）。根据平均手术时间、出血量、住院时间、住院费用、视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）、红细胞沉降率（ESR）、C反应蛋白（CRP）、神经功能恢复情况、骨性融合、椎间高度、Cobb角及术后并发症等评价临床疗效。最终随访时间平均为 35.5 个月，范围为 15 至 56 个月。所有患者均完全治愈并获得牢固的骨融合。骨融合时间A1组为9.4±6.1个月，A2组为10.2±2.7个月，B1组为8.7±3.6个月。三组间差异无显着性（P>0.05）。 Cobb矫正及椎间高度恢复较术前明显改善，但三组间差异无统计学意义（P>0.05）。 A1组的角度矫正损失和椎间高度损失均小于B1组（P<0.05），但A1组与A2组、A2组与B1组之间差异无统计学意义（P>0.05）。 B1组患者的角度矫正和椎间高度损失最大。此外，手术后神经功能也显着改善。术后末次随访时VAS、ODI、ESR、CRP比较差异有统计学意义（P<0.05），三组间比较差异无统计学意义（P>0.05）。三组失血量、住院天数、住院费用、矫正费用比较，差异无统计学意义（P>0.05）。并发症包括脑脊液漏（A1组和A2组2例）、窦道形成（A1组、A2组和B1组3例）和椎间感染（B1组1例），但所有患者均未发现种植体失败或供区并发症。钛网笼治疗单节段脊柱结核可获得与自体髂骨移植相当的良好临床疗效，治疗多节段脊柱结核可能优于自体髂骨移植。
To compare the clinical efficacy of titanium mesh cages and autogenous iliac bone graft to restore vertebral height through posterior approach in patients with thoracic and lumbar spinal tuberculosis. 59 patients with spinal tuberculosis underwent interbody fusion and internal fixation through posterior approach in our department from January 2011 to December 2013. In group A, 34 patients obtained titanium mesh for the reconstruction of vertebral height, among them 25 patients (group A1) suffered from single-segment spinal tuberculosis, and 9 patients, (group A2) had multi-segment spinal tuberculosis. In group B, 25 patients got autogenous iliac bone graft to restore vertebral height, including 24 patients with single-segment spinal tuberculosis (group B1), and 1 patient with multi-segment spinal tuberculosis (group B2). The clinical efficacy was evaluated based on average operation time, blood loss, hospital stays, hospitalization expenses, visual analog scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), neurological function recovery, bony fusion, intervertebral height, Cobb angle and postoperative complications. Final follow-up time was an average of 35.5 months ranging from 15 to 56 months. All patients were completely cured and obtained solid bone fusion. The bony fusion time was 9.4±6.1 months in group A1, 10.2±2.7 months in group A2 and 8.7±3.6 months in group B1. There were no significant difference among three groups (P>0.05). The Cobb correction and restoration of intervertebral height significantly improved compared with those in preoperation, but without significant difference among three groups (P>0.05). The loss of angular correction and intervertebral height in group A1 were found to be less than those in group B1 (P<0.05), but with no significant difference between group A1 and group A2, and between group A2 and group B1 (P>0.05). Patients in group B1 got the most loss of angular correction and intervertebral height. In addition, neurological function was revealed to be significantly improved after surgery. There were significant differences of VAS, ODI, ESR and CRP between preoperation and postoperation at the final follow-up time (P<0.05), with no significant difference among three groups (P>0.05). No statistically significant difference was found when analyzing blood loss, hospital stays, hospitalization expenses, and corrective cost among three groups (P>0.05). Complications included cerebrospinal fluid leakage (2 cases in group A1 and group A2), sinus formation (3 cases in group A1, group A2 and group B1), and intervertebral infection (1 case in group B1), but no implant failure or donor site complications was found in any patient. Titanium mesh cages could obtain good clinical efficacy comparable to autogenous iliac bone graft when treating single-segment spinal tuberculosis, and may be better than autogenous iliac bone graft for treating multi-segment spinal tuberculosis.