黄福立 张振山 刘永恒 吴俊哲 张明友 高凯麒 李健

【摘要】目的 探討自体颗粒骨打压植骨治疗下腰椎结核的临床疗效。方法 将35例L3～S1下腰椎结核患者分为观察组（18例）与对照组（17例），前者采用自体颗粒骨打压植骨联合椎弓根钉进行椎间融合，后者采用椎间融合器进行椎间融合，2组术后均严格佩戴腰部支具3个月，行规范抗结核治疗12 ～ 18个月，比较2组的临床疗效（Macnab法）以及术前、术后1个月与随访时的X线片结果（椎间隙高度、cobb角）、疼痛改善情况（Oswestry功能障碍指数问卷表）及自体颗粒骨椎间打压植骨融合情况。结果 所有患者术程均顺利，均无手术并发症，随访14个月（9 ～ 20个月）。2组临床疗效比较差异无统计学意义（P > 0.05）。观察组术后1个月及末次随访时的疼痛改善情况均优于对照组（P均< 0.001）。观察组术后1个月的cobb角及末次随访的椎间高度情况优于对照组（P均< 0.05），但术后1个月2组的椎间高度情况无差异（P > 0.05）。结论 自体颗粒骨打压植骨联合椎弓根钉进行椎间融合的临床疗效与常用的椎间融合器相当，但术后疼痛及椎间高度的改善情况优于后者。

【关键词】脊柱结核;下腰椎;椎间融合;自体颗粒骨

【Abstract】Objective To evaluatethe clinical efficacy of autogenousmorselizedand impacted bone graft in the treatment of lower lumbar tuberculosis.  Methods Thirty-five patients with lower lumbar tuberculosis （L3-S1） were randomly divided into the observation （n = 18） and control groups （n = 17）. In the observation group，autogenousmorselizedand impacted bone graft combinedwith pedicle screw for intervertebral fusion was adopted. In the control group，interbody fusion cage was employed for intervertebral fusion. All patients were strictly required to wear the lumbar bracefor 3 months after surgery and receive standardized anti-tuberculosis treatment for 12 to 18 months. The clinical efficacy （Macnab method）， intervertebral disc space height and cobb angle by X-ray examination， pain alleviation （Oswestry Disability Index Questionnaire） and bone graft fusion of autogenousmorselizedand impacted bone were compared before treatment， 1 month after treatment and during follow-up.  Results All patients successfully completed the surgery without surgical complications. The mean follow-up time was 14 months （9-20 months）. The clinical efficacy did not significantly differ between two groups （P > 0.05）. At 1 month after treatment and the final follow-up， the pain alleviation in the observation group was significantly higher than that in the control group （both P < 0.001）. At 1 month after treatment， the cobb angle in the observation group was remarkably better compared with that in the control group. At the final follow-up， intervertebral disc space height in the observation group was remarkably better compared with that in the control group （both P < 0.05）. Nevertheless， the intervertebral disc space height at postoperative 1 month did not significantly differ between two groups （P > 0.05）.  Conclusion Autogenousmorselizedand impacted bone graft combined with pedicle screw fixation yields equivalent clinical efficacy with conventional intervertebral fusion cage， whereas has advantages in terms of the improvement of postoperative pain and intervertebral disc space height.

【Key words】Spinal tuberculosis;Lower lumbar vertebrae;Intervertebralfusion;Autogenousbone graft

近年来脊柱结核的发病率有上升趋势，对于药物疗效欠佳的脊柱结核患者，多采用外科治疗。下腰椎结核多伴有脊柱畸形、失稳及脊髓神经损伤症状，治疗方法多种多样[1]。临床常使用椎间融合器作椎间融合以复位伤椎椎体，该技术可避免损伤椎体对腹膜后器官及大血管的损害，而且可较大程度减轻脊神经的压力[2]。近年来，脊柱后路切开减压复位、病灶清除、植骨融合椎弓根钉棒系统固定在临床已被广泛应用。腰椎……