摘要目的 探讨一期前路同种异体髂骨块与自体髂骨块移植治疗胸腰椎结核的安全性、可行性及临床疗效.方法 回顾性分析2012年1月至2015年6月于我科行一期前路病灶清除同种异体髂骨块或自体髂骨块植骨融合内固定术治疗的235例胸腰椎结核患者的临床资料,将其分为同种异体髂骨块组和自体髂骨块组.同种异体髂骨块组162例,男87例,女75例,年龄2~80岁,平均42.5岁;自体髂骨块组73例,男41例,女32例,年龄14~68岁,平均40.3岁.对比两组患者手术前后及末次随访资料,对两组患者的手术时间、术中出血量、住院时间、红细胞沉降率、C反应蛋白、视觉疼痛模拟(vi-sual analogue scale,VAS)评分、日本骨科协会(Japanese Orthopaedic Association,JOA)评估治疗评分、美国脊柱损伤协会(American Spinal Injury Association,ASIA)脊髓损伤分级改善及植骨融合满意率进行分析.结果 同种异体髂骨块组手术时间平均(122.41±30.55)min,明显少于自体髂骨块组(141.56±25.69)min,差异有统计学意义.术后组内的VAS评分、JOA评分、红细胞沉降率、C反应蛋白及ASIA分级均较术前明显改善,差异有统计学意义,但两组间比较的差异无统计学意义;同种异体髂骨块组术后3个月红细胞沉降率为(16.46±7.39)mm/h,明显高于自体髂骨块组(13.61±6.85)mm/h,差异有统计学意义.同种异体髂骨块组植骨融合时间(8.13±1.97)个月,较自体髂骨块组(5.37±1.72)个月明显延长,差异有统计学意义;末次随访时ASIA分级有效改善率及植骨融合满意率,两组的差异均无统计学意义.围手术期并发症:胃肠功能障碍5例(同种异体髂骨块组3例,自体髂骨块组2例),肺部感染6例(同种异体髂骨块组4例,自体髂骨块组2例).术后并发症:后凸畸形4例(同种异体髂骨块组3例,自体髂骨块组1例),结核复发5例(同种异体髂骨块组3例,自体髂骨块组2例),窦道形成5例(同种异体髂骨块组3例,自体髂骨块组2例),髂骨取骨区慢性疼痛自体髂骨块组6例.结论 同种异体髂骨块移植与自体髂骨快移植治疗胸腰椎结核的临床疗效无明显差异,同种异体髂骨块可以成为自体髂骨块的理想替代材料用于胸、腰椎结核的临床治疗.

abstractsObjective To evaluate the safety, feasibility and clinical efficacy of one-stage anterior transplantation with ili-ac crest allograft or autologous in the treatment of thoracolumbar tuberculosis. Methods From January 2012 to June 2015, 235 cases of thoracolumbar tuberculosis were treated with allogeneic or autologous iliac crest graft combined with internal fixation dur-ing one-stage after radical debridement, which were reviewed retrospectively. These cases were divided into two groups:allograft group (162 cases) and autograft group (73 cases). In allograft group, there were 87 males and 75 females, with a mean age of 42.5 (range 2-80) years. In autograft group, there were 41 males and 32 females, with a mean age of 40.3 (range 14-68) years. The oper-ation time, bleeding volume, hospital stay, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, visual ana-logue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, the changes of American Spinal Injury Association (ASIA) scale for neurological classification of spinal and graft fusion satisfaction rate in each groups were evaluated respectively before and after surgery. Results The operation time was (122.41±30.55) min in allograft group and (141.56±25.69) min in auto-graft group, the difference was statistically significant. The average hospital stay and bleeding volume were no significant differ-ence between the two groups. In each group, VAS scores, JOA scores, ESR and CRP level and the changes of ASIA scale were sig-nificant difference between pre-and post-operation, but these index showed that there were no significant differences between the two groups. The mean ESR level was (16.46±7.39) mm/h in allograft group, and (13.61±6.85) mm/h in autograft group 3 months af-ter the operation. The fusion time (8.13 ± 1.97) months in allograft group was significantly longer than that in autograft group (5.37± 1.72) months, the difference was statistically significant. At final follow-up, the graft fusion satisfaction rate and the changes of ASIA showed no significant difference. Perioperative complications including gastrointestinal dysfunction in 5 cases (allograft group in 3cases;autograft group in 2cases), and pulmonary infection in 6 cases (allograft group in 4cases;autograft group in 2cas-es). Postoperative complications including kyphosis in 4 cases (allograft group in 3cases;autograft group in 1case), tuberculosis re-currence in 5 cases (allograft group in 3cases;autograft group in 2cases), sinus formation in 5 cases (allograft group in 3cases;auto-graft group in 2cases), chronic pain of the donor site in 6 cases (group autograft). Conclusion There was no significant difference between allogeneic iliac graft and autologous iliac graft in the treatment of thoracolumbar tuberculosis. Allogeneic iliac bone may be the ideal substitute of autologous iliac bone for the clinical treatment of thoracolumbar tuberculosis.