| 李硕,李领娣,张建志,等.三种植骨材料局部植骨治疗骶髂关节结核的疗效比较.骨科,2023,14(6): 540-546. |
| 三种植骨材料局部植骨治疗骶髂关节结核的疗效比较 |
| Comparison of Curative Effect of Local Bone Grafting with Three Implanted Bone Materials in the Treatment of Sacroiliac Joint Tuberculosis |
| 投稿时间：2023-08-17 |
| DOI：10.3969/j.issn.1674-8573.2023.06.010 |
| 中文关键词: 局部植骨 自体髂骨 同种异体骨 Osteoset人工骨 骶髂关节结核 |
| 英文关键词: Local bone grafting Autologous iliac Allogeneic bone Osteoset artificial bone Tuberculosis of the sacroiliac joint |
| 基金项目:河北省重点科技研究计划项目（20180662） |
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| 中文摘要: |
| 目的 比较三种植骨材料局部植骨治疗骶髂关节结核的疗效。方法 回顾性选取2015年2月至2021年1月我院收治的65例骶髂关节结核病人作为研究对象，骶髂关节结核病灶清除术后，27例予以载有利福平的医用硫酸钙颗粒（Osteoset人工骨组）、21例采用同种异体骨（同种异体骨组）、17例采用自体髂骨（自体髂骨组），实施局部植骨融合术。比较三组手术时间、红细胞沉降率、术中出血量、融合分级与腰骶角、植骨愈合时间、腰骶部疼痛与下肢放射疼痛视觉模拟量表（visual analogue scale，VAS）评分、骨代谢标志物［骨钙素、β-胶原特殊序列（β-CTx）、1型胶原氨基端延长肽（P1NP）］、骨盆功能临床分级、并发症、复发率。结果 三组术后红细胞沉降率均低于术前，腰骶角均高于术前（P＜0.05）；三组手术时间、术中出血量、红细胞沉降率、腰骶角的差异无统计学意义（P＞0.05）。三组在随访中均未发现Ⅳ级融合，Osteoset人工骨组植骨融合时间短于自体髂骨组、同种异体骨组（P＜0.05）；三组术后18个月融合分级比较，差异无统计学意义（P＞0.05）。三组术后2周、4周腰骶部疼痛与下肢放射痛VAS评分均低于术前（P＜0.05），组间的差异无统计学意义（P＞0.05）。三组术后2周、术后4周骨钙素、P1NP均高于术前（P＜0.05）；Osteoset人工骨组术后2周、术后4周骨钙素、P1NP高于自体髂骨组、同种异体骨组（P＜0.05）。三组术后18个月骨盆功能优良率比较，差异无统计学意义（P＞0.05）；三组并发症、复发率比较，差异无统计学意义（P＞0.05）。结论 病灶清除术联合自体骨、同种异体骨、人工骨移植治疗骶髂关节结核均能获得满意效果，其中载有注射用利福平的医用硫酸钙颗粒在缩短植骨融合时间、诱导骨形成中更有优势。 |
| 英文摘要: |
| Objective To compare the efficacy of local bone grafting with three implant materials in the treatment of sacroiliac joint tuberculosis. Methods A total of 65 patients with sacroiliac joint tuberculosis admitted to our hospital from February 2015 to January 2021 were retrospectively selected as the study objects. After the removal of sacroiliac joint tuberculosis focus, 27 cases were treated with medical calcium sulfate particles containing rifampicin (Osteoset artificial bone group), 21 cases were treated with allograft bone (allografts group), and 17 cases were treated with autologous iliac bone (autologous iliac group) for local bone graft fusion. The surgical time, erythrocyte sedimentation rate (ESR), intraoperative bleeding volume, fusion grade and lumbosacral angle, bone graft healing time, visual analogue scale (VAS) scores for lumbosacral pain and lower limb radiation pain, bone metabolic markers ［Osteocalcin, β-Collagen special sequence (β-CTx), procollagen type I N-terminal propetide (P1NP)］, clinical grading of pelvic function, complications, and recurrence rate were compared among three groups. Results The ESR in all three groups was lower, and the lumbosacral angle was higher than those before surgery (P＜0.05). There was no significant difference in operation time, intraoperative blood loss, ESR, and lumbosacral angle among the three groups (P＞0.05). No grade Ⅳ fusion was found in all three groups during the follow-up period, and the fusion time in the Osteoset artificial bone group was shorter than that in the autologous iliac bone group and allograft bone group (P＜0.05). There was no significant difference in fusion grade among the three groups at 18th month after surgery (P＞0.05). The VAS scores of lumbosacral pain and lower limb radiating pain in all three groups were lower at 2nd week and 4th week after surgery than those before surgery (P＜0.05); there was no significant difference in VAS scores of lumbosacral pain and lower limb radiating pain among the three groups at 2nd and 4th week after surgery (P＞0.05). The bone calcium and P1NP levels in all three groups were higher at 2nd and 4th week after surgery those those before surgery (P＜0.05). The bone calcium and P1NP levels in the Osteoset artificial bone group were higher than those in the autologous iliac bone group and allograft bone group at 2nd and 4th week after surgery (P＜0.05). There was no significant difference in the excellent and good rate of pelvic function among the three groups at 18th month after surgery (P＞0.05). There was no significant difference in the complication and recurrence rate among the three groups (P＞0.05). Conclusion Debridement combined with autologous bone, allogeneic bone and artificial bone transplantation in the treatment of sacroiliac joint tuberculosis can achieve satisfactory results, and the medical calcium sulfate particles containing rifampicin for injection has more advantages in shortening the fusion time and inducing bone formation. |
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