摘要目的:比较单节段胸椎及胸腰段结核前路病灶清除植骨融合手术中肋骨或髂骨自体移植的疗效。方法:回顾性分析2014年1月至2024年3月于四川大学华西医院骨科接受前路病灶清除植骨融合内固定手术治疗108例脊柱结核患者的资料，男54例、女54例，年龄（45.10±15.35）岁（范围为17~76岁）。病变节段：胸椎48例（T 4，5节段2例、T 7，8节段7例、T 8，9节段4例、T 9，10节段6例、T 10，11节段13例、T 11，12节段16例）及胸腰段60例（T 12L 1节段32例、L 1，2节段28例）。按植骨方式分为肋骨植骨组（采用编织肋骨植骨）68例和髂骨植骨组（采用结构性髂骨植骨）40例。比较两组患者手术时间、术中失血量、术后引流量、住院时间、并发症发生情况、红细胞沉降率（erythrocyte sedimentation rate，ESR）、C反应蛋白（C-reactive protein，CRP）、节段后凸角、融合节段高度、疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、骨融合时间和美国脊柱损伤协会（American Spinal Injury Association，ASIA）脊髓损伤分级。 结果:108例患者均获得随访，随访时间12~72个月，肋骨植骨组为（68.70±26.25）个月，髂骨植骨组为（68.70±26.22）个月。两组患者性别、年龄、术中出血量、术后引流量、住院时间、骨融合时间、节段后凸角、融合节段高度，术前、术后3个月和末次随访的ESR、CRP水平，术前和末次随访的ODI和疼痛VAS的差异均无统计学意义（ P>0.05）。肋骨植骨组手术时间为（228.6±45.7）min，短于髂骨植骨组的（254.5±32.9）min，差异有统计学意义（ t=2.965， P=0.004）。术后1周肋骨植骨组疼痛VAS为（3.70±0.44）分，较髂骨植骨组的（4.68±0.81）分低（ t=6.477， P<0.001）；末次随访时肋骨植骨组节段后凸角及矫正丢失量分别为18.54°±7.45°和5.14°±3.22°，大于髂骨植骨组的14.75°±7.72°和3.34°±3.14°（ t=2.370， P=0.019； t=0.052， P=0.009）；肋骨植骨组融合节段高度矫正丢失量为（0.43±0.31）cm，大于髂骨植骨组的（0.21±0.35）cm（ t=0.763， P=0.002）。随访期间所有患者结核病灶均未复发，未发生感染、下肢深静脉血栓形成、骨不愈合或延迟愈合等并发症。 结论:编织肋骨植骨具有手术时间短、术后疼痛轻的优势；而结构性髂骨植骨在维持脊柱序列稳定及融合节段高度方面更具长期优势。

abstractsObjective:To compare the clinical efficacy of autologous rib grafting versus structural iliac crest grafting in anterior debridement with interbody fusion and internal fixation for single-segment thoracic or thoracolumbar spinal tuberculosis.Methods:A retrospective analysis was performed on 108 consecutive patients with spinal tuberculosis who underwent anterior lesion debridement, bone graft fusion, and internal fixation in the Department of Orthopedics, West China Hospital of Sichuan University, between January 2014 and March 2024. The cohort included 54 males and 54 females, with a mean age of 45.10±15.35 years (range, 17-76 years). Lesions involved the thoracic spine in 48 cases (T 4, 5, 2; T 7, 8, 7; T 8, 9, 4; T 9, 10, 6; T 10, 11, 13; T 11, 12, 16) and the thoracolumbar junction in 60 cases (T 12L 1, 32; L 1, 2, 28). According to graft type, patients were allocated to a rib group (autologous rib grafting; 68 cases) or an iliac bone group (structural iliac crest grafting; 40 cases). Outcomes included operative duration, intraoperative blood loss, postoperative drainage volume, length of hospital stay, complication incidence, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), segmental vertebral kyphosis angle, intervertebral height, visual analogue scale (VAS) pain score, Oswestry Disability Index (ODI), fusion time, and American Spinal Injury Association (ASIA) grade. Results:All 108 patients were followed for 12-72 months. The mean follow-up duration was 68.70±26.25 months in the rib group and 68.70±26.22 months in the iliac bone group. No significant between-group differences were identified in sex, age, intraoperative blood loss, postoperative drainage volume, hospital stay, bone union time, correction of segmental kyphosis angle, intervertebral height, ESR and CRP levels (preoperatively, at 3 months postoperatively, and at final follow-up), or ODI and VAS (preoperatively and at final follow-up) ( P>0.05). Operative duration was significantly shorter in the rib group (228.6±45.7 min) than in the iliac bone group (254.5±32.9 min; t=2.965, P=0.004). At 1 week postoperatively, the VAS was higher in the iliac bone group (4.68±0.81) than in the rib group (3.70±0.443). At final follow-up, loss of segmental kyphosis angle correction was greater in the rib group (18.54°±7.45°) than in the iliac bone group (14.75°±7.72°), and intervertebral height loss in the iliac bone group (0.43±0.31 cm) was smaller than that in the rib group (0.21±0.35 cm). These between-group differences were statistically significant ( t=6.477, P<0.001; t=2.370, P=0.019; t=0.002, P=0.002). No postoperative recurrence of spinal tuberculosis was observed. No complications, including infection, lower-limb deep vein thrombosis, nonunion, or delayed union, were detected. Conclusions:Autologous rib grafting offers the advantages of shorter operative duration and less early postoperative pain, whereas structural iliac crest grafting confers superior long-term maintenance of spinal alignment and intervertebral height. Structural iliac crest grafting may be preferable for patients with higher requirements for long-term spinal stability.