颗粒植骨，钛网植骨和髂骨植骨在后入路单节段腰椎结核病灶清除术中的疗效研究

目的　比较颗粒植骨，钛网植骨和自体髂骨植骨在后入路单节段腰椎结核病灶清除术中的临床疗效。 方法　回顾性分析本科2015年7月至2020年9月接受后入路单节段腰椎结核病灶清除 + 植骨融合内固定术的98例患者，其中32例自体髂骨植骨，32例钛网植骨，34例颗粒植骨。主要的观察指标包括：手术时间，术中出血量，术后住院时间，VAS评分（visual analogue scale，VAS），血细胞沉降率，C反应蛋白和美国脊髓损伤协会分级；次要参考指标：矫正和丢失Cobb角，植骨融合时间。记录所有参考数据并进行统计学分析。 结果　术后平均随访时间为28月（14 ~ 53月）。颗粒组手术时间（192.6±42.2）min，植骨融合时间（5.2±1.1）月，均优于髂骨块组（229.2 ± 61.6）min，（8.0 ± 2.9）月和钛网组（233.1±51.1）min，（8.6±5.6）月，P<0.05。术中出血量颗粒组（385.3±251.8）ml，少于钛网组（660.9 ± 486.4）mL，P<0.05；与髂骨块组（534.4 ± 395.4）ml无统计学差异，P＝0.122。术后末次随访患者腰椎节段后凸Cobb角均较术前显著改善（P<0.05），丢失及矫正Cobb角各组间无统计学差异（P>0.05）。余指标3组间无统计学差异。 结论　与髂骨块植骨和钛网植骨相比，颗粒骨植骨简单易行，手术时间短，术中出血量少，术后植骨融合快，应用于后入路单节段腰椎结核术中，是一种安全，有效的植骨方式。

Study on the curative effects of granular bone graft,titanium mesh bone graft and iliac bone graft in single-segment lumbar tuberculosis focus debridement by posterior approach

Objective　To compare the clinical outcomes of iliac bone graft, titanium mesh bone graft and granular bone graft in the surgical treatment of single segment lumbar tuberculosis.　Methods　A retrospective analysis was performed on 98 patients who underwent one stage posterior debridement, bone graft and internal fixation for single segment lumbar tuberculosis from July 2015 to September 2020, involving 32 case in autologous iliac bone graft group, 32 case in titanium mesh bone graft group and 34 cases in granular bone graft group. The operative time, intraoperative blood loss, postoperative hospital stay, visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ASIA grade, Cobb angle correction and loss, and bone graft fusion time were recorded and analyzed.　Results　The average follow-up time was 28 months (14~53 months). The operation time and bone graft fusion time in the granular group were (192.6±42.1) min, (5.2±1.1) months, which were better than those in the iliac bone group (229.2±61.6) min, (8.0±2.9) months and titanium mesh group (233±51.5) min, (8.6±5.6) months (P<0.05). The amount of intraoperative blood loss in the granular group (385.3±251.8) mL was less than that in the titanium mesh group (660.9±486.4) mL (P<0.05), but there was no significant difference in the amount of intraoperative blood loss between the granular group and the iliac bone group (534.4±395.4) mL, (P=0.122). After operation, the Cobb angle of lumbar segmental kyphosis significantly improved in the three groups at the last follow-up, but there was no significant difference in loss and correction of Cobb angle among the three groups (P>0.05). There were no statistical difference in the other indicators among the three groups.　Conclusions　Compared with iliac bone graft and titanium mesh bone graft, granular bone graft has the advantages of simple and feasible operation, shorter operation time, less blood loss and faster postoperative bone graft fusion. It is a safe and effective bone graft method for single segmental lumbar tuberculosis via posterior approach.