| BackgroundVertebral could be destroyed by lumbar tuberculosis,so when the lesion is removed,the bone defect of thevertebralmay lead to spinal instability.In clinical work,bone grafting for bone defects and deformities is needed to promote vertebral fusionand to reconstruct the function of the spine.At present,the most widely used bone grafting materials are autogenous bone,which have been widely recognized by clinicians because of its advantages such as without immune rejection and with higher bone graft fusion rate.However,there are some problems such as limited amount of autogenous bone and chronic pain.Therefore,the search for suitable bone graft fusion materials is one of the hot spots of clinicians.Although there have been a lot of reports in recent years about the replacement of autologous bone with synthetic bone,there are still some controversies about this method.ObjectiveTo compare the clinical efficacy of iliac bone graft or β-tricalcium phosphate bone graft in the surgical treatment of single segment lumbar tuberculosis.To explore the advantages and disadvantages of β-tricalcium phosphate synthetic bone and autogenous iliac bone in the case of bone grafting for lumbar tuberculosis,in order to provide some evidence for the selection of appropriate bone grafting materials for patients with spinal tuberculosis in the future clinical work.Methods61 patients who underwent anterior and posterior debridement,bone graft and internal fixation for single segment lumbar tuberculosis from June 1 in 2014 to June 1 in 2018 were involved in this study,involving a group with 33 cases in iliac bone graft,another group with 28 cases in β-tricalcium phosphate bone graft.Operation-related indexes,inflammatory indexes,functional score indexes,imaging indexes and postoperative complications were compared between the two groups.Surgery-related indicators included operative time,intraoperative blood loss,postoperative hospital stay,etc.The inflammatory indexes included erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)at 1 month after surgery and the last follow-up;Functional scores included VAS score and ODI score at 1 month and last follow-up;Imaging evaluation indexes included bone graft fusion time and Cobb Angle loss degree in sagittal view.Postoperative complications include: incision nonunion rate,pulmonary infection,urinary system infection,electrolyte disturbance,gastrointestinal dysfunction,recurrence rate of tuberculosis and other indicators.Results1.Comparison of operation-related indexes between the two groups: there was no statistical significance in operative time and intraoperative blood loss(P>0.05);The postoperative hospital stay of autogenous iliac group was shorter than that of synthetic bone group(P<0.05).2.Comparison of inflammatory indexes between the two groups: postoperative erythrocyte sedimentation rate and C-reactive protein in the two groups were decreased compared with preoperative levels,and the decrease was higher in the autogenous iliac group than in the synthetic bone group 1 month after surgery,with statistical significance(P<0.05).At the last follow-up,both groups were reduced to normal level,and there was no statistical significance between the two groups(P>0.05).3.Comparison of functional evaluation indexes between the two groups:postoperative VAS score and ODI score in the two groups were decreased compared with preoperative levels,and the decrease was higher in the autogenous iliac group than in the synthetic bone group 1 month after surgery,with statistical significance(P<0.05)At the last follow-up,there was no significant difference in VAS score and ODI score between the two groups(P>0.05).4.Comparison of imaging indexes between the two groups: fusion time of 8.6±1.3(m)in the autogenous iliac group was lower than that of the synthetic bone group(9.6±1.9(m),the difference was statistically significant(P<0.05).The loss of Cobb Angle in the last follow-up was lower in the autogenous iliac group than in the synthetic bone group,and the difference was statistically significant(P<0.05).5.Comparison of postoperative complications between the two groups: there was no statistical difference in the incidence of total postoperative complications between the two groups(P>0.05).The synthetic bone group has a higher risk of inflammation.The incidence of incision nonunion and the recurrence rate of tuberculosis in the synthetic bone group was higher than that in the autogenous iliac group,the difference was statistically significant(P<0.05).ConclusionsIn patients with single segmental lumbar tuberculosis who underwent anterior and posterior debridement with bone graft and internal fixation,there was a higher risk of inflammation,incision nonunion and slower bone graft fusion in the synthetic bone group than that in the autogenous iliac group.The use of synthetic β-tricalcium phosphate bone grafts in patients with lumbar tuberculosis should still be treated with caution,Autogenous iliac bone should be given priority. |
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