摘要目的 评价前路病灶清除植骨内固定治疗颈椎结核的手术中,采用钛网充填异体骨植骨的临床应用价值.方法 回顾性研究2002年1月至2007年1月间,行前路病灶清除植骨内固定手术治疗且随访2年以上的颈椎结核病例共32例.其中,男性18例,女性14例;年龄18～72岁,平均41.3岁.发病至就诊时间0.5～15.0个月,平均6.9个月.初治患者13例,复治患者19例.根据植骨来源不同分为A、B两组,A组17例采用钛网充填异体骨植骨,B组15例采用自体髂骨块植骨.随访时间2-5年,平均3.5年.比较两组间手术时间、出血量、结核治愈情况、颈椎生理曲度(ARA角)变化、颈脊髓功能(40分评分)及植骨融合率等.结果 切口一期愈合率93.8%(30/32),总治愈率为96.9%(31/32).A、B组间切口一期愈合率及总治愈率差异均无统计学意义(P>0.05).两组平均手术时间分别72、90 min,平均出血量分别为121、198 ml;两组比较差异均有统计学意义(P<0.05).两组组内比较,术前与术后即刻、术前与术后末次随访时、术后即刻与术后末次随访颈脊髓功能差异均有统计学意义(P<0.05);术前与术后即刻、术前与术后末次随访时颈椎绝对旋转角(ARA角)差异均有统计学意义(P<0.05),术后即刻与术后末次随访之ARA角差异均无统计学意义(P>0.05).两组组间比较:术前、术后即刻、术后末次随访之颈脊髓功能及ARA角差异均无统计学意义(P>O.05).结论 在个体化有效抗痨的基础上,应用前路病灶清除减压、一期钛网内充填异体骨植骨内固定治疗颈椎结核,临床疗效满意.

abstractsObjective To evaluate the exploratory development of bone graft by titanium mesh with bone allograft in treatment of cervical spinal tuberculosis. Methods Thirty two cases of cervical spinal tuberculosis treated with anterior radical debridement, decompression and inter fixation from January 2002 to January 2007 were included (at least two years follow-up). 18 male and 14 female, age from 18 to 72, mean 41.3 years old. 0. 5-15. 0 months before visit, mean 6. 9 months. There were 13 cases in initial treatment group and 19 cases in retreatment group. All cases were divided into two groups (group A and group B) by resource of bone graft. Group A, titanium mesh with bone allograft, 17 cases. Group B, autograft with ilium, 15 cases. Operation time, blood loss, curing conditions, cervical curvature (absolute rotation angle,ARA), function of spinal cord and the rate for bone graft fusions in two groups were compared. The mean follow-up was 3.5 years ( range 2-5 years). Results The primary healing rate of incisions was 93. 8% (30/32), and total healing rate was 96.9% (31/32). There were no significant differences in operation time or in blood loss between two groups ( P > 0. 05 ). Operation time and blood loss, 72 min/121 ml in group A and 90 min/198 ml in group B, there were significant differences between two groups (P<0.05). In each group, there were significant differences in the function of spinal cord between preoperative and immediately post operative, between preoperative and follow-up, and between immediately post operative and follow-up ( P < 0. 05 ), and there were significant differences in ARA between preoperative and immediately post operative, and between preoperative and follow-up (P<0. 05 ), and there were no significant differences between immediately pest operative and follow-up (P > 0. 05 ). On preoperative, immediately post operative and follow-up, there were no significant differences in the function of spinal cord or in ARA between two groups ( P > 0. 05 ). Conclusion For cervical spinal tuberculosis followed by effective individual chemotherapy, a good effect can be obtained by treated with radical debridement and boneallograft with titanium mesh.