Shi Jiandang, Wang Zili, Wang Pei, Jin Weidong
Department of Orthopaedics, the General Hospital of Tianjin Medical University, Tianjin 300052, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Nov;25(11):1290-3.
To evaluate the clinical results of allogeneic bone graft for interbody fusion in cervical tuberculosis.
Between January 2000 and January 2008, 30 cases of cervical tuberculosis were treated with allogeneic (group A, n = 15) or autologous (group B, n = 15) iliac crest bone graft combined with anterior fixation after radical debridement. In group A, there were 8 males and 7 females with an average age of 38 years; the disease duration was 6 to 14 months; the preoperative kyphosis Cobb angle was (8.6 +/- 11.3) degrees; the preoperative Japanese Orthopaedic Association (JOA) score was 13.0 +/- 3.1 for neurological function; and the length of bone graft was 32 mm on average. In group B, there were 9 males and 6 females with an average age of 42 years; the disease duration was 4 to 17 months; the preoperative kyphosis Cobb angle was (4.9 +/- 7.4) degrees; the preoperative JOA score 12.3 +/- 4.2; and the length of bone graft was 34 mm on average. There was no significant difference in general data between 2 groups (P > 0.05).
The operation time and bleeding volume in group A were significantly less than those in group B (P < 0.05). Wound effusion were found in 2 cases of group A, and the other incisions healed by first intention. No infection occurred in group B. In group A, 13 cases were followed up 12-48 months; in group B, 14 cases were followed up 13-46 months. The time of bone graft healing in group A [(7.6 +/- 2.1) months] was significantly longer than that in group B [(4.2 +/- 1.1) months] (t = 2.773, P = 0.005). The kyphosis Cobb angles were significantly improved at 6 months and last follow-up after operation in 2 groups when compared with that before operation (P < 0.05), but no significant difference was found between 2 groups at different time after operation (P > 0.05). There was no significant difference in JOA score at 6 months after operation between group A (14.1 +/- 2.6) and group B (14.3 +/- 2.4) (t = 1.655, P = 0.162). The improvement rate for neural function were 83.7% in group A and 87.8% in group B, showing no significant difference (chi2 = 3.150, P = 0.071). There was no loosening of internal fixation and recurrence of tuberculosis in 2 groups during follow-up. Five cases had chronic pain at iliac donor sites in group B. According to Bridewell et al. evaluation standard, the bone fusion was satisfactory in 11 cases (84.6%) and unsatisfactory in 2 cases (15.4%) in group A, and was satisfactory for all in 14 cases (100%) in group B. The satisfactory rate of bone fusion showed no significant difference between 2 groups (chi2 = 2.680, P = 0.115).
Allogeneic bone grafting has a good clinical result for spinal fusion in cervical tuberculosis surgery, which can treat tuberculosis bone defect effectively.
评估同种异体骨移植用于颈椎结核椎间融合的临床效果。
2000年1月至2008年1月，30例颈椎结核患者在病灶清除术后，采用同种异体骨移植（A组，n = 15）或自体髂骨移植（B组，n = 15）并前路固定治疗。A组中，男8例，女7例，平均年龄38岁；病程6至14个月；术前后凸Cobb角为(8.6±11.3)度；术前日本骨科学会（JOA）神经功能评分为13.0±3.1；平均植骨长度为32 mm。B组中，男9例，女6例，平均年龄42岁；病程4至17个月；术前后凸Cobb角为(4.9±7.4)度；术前JOA评分为12.3±4.2；平均植骨长度为34 mm。两组一般资料比较差异无统计学意义（P > 0.05）。
A组手术时间和出血量明显少于B组（P < 0.05）。A组有2例出现伤口积液，其余切口均一期愈合。B组无感染发生。A组13例随访12至48个月；B组14例随访13至46个月。A组植骨愈合时间[(7.6±2.1)个月]明显长于B组[(4.2±1.1)个月]（t = 2.773，P = 0.005）。两组术后6个月及末次随访时后凸Cobb角与术前比较均明显改善（P < 0.05），但术后不同时间两组间比较差异无统计学意义（P > 0.05）。术后6个月A组JOA评分为(14.1±2.6)，B组为(14.3±2.4)，差异无统计学意义（t = 1.655，P = 0.162）。A组神经功能改善率为83.7%，B组为87.8%，差异无统计学意义（χ2 = 3.150，P = 0.071）。随访期间两组均无内固定松动及结核复发。B组有5例髂骨供区出现慢性疼痛。根据Bridewell等的评估标准，A组11例（84.6%）骨融合满意，2例（15.4%）不满意；B组14例（100%）均满意。两组骨融合满意率比较差异无统计学意义（χ2 = 2.680，P = 0.115）。
同种异体骨移植用于颈椎结核手术脊柱融合临床效果良好，能有效治疗结核性骨缺损。
