自体富血小板血浆在脊柱结核病灶清除植骨融合术中的临床应用和疗效分析

摘要

Objective To discuss clinical application and curative effect of autologous platelet rich plasma (PRP) in spinal tuberculosis bone fusion surgical treatment.Methods From March 2013 to March 2016,in Qinghai University Affiliated Hospital,32 patients with spinal tuberculosis who were all from Qinghai area were selected.Patients given autologous PRP mixture with artificial bone in spinal tuberculosis were selected as PRP group (16 cases),patients with artificial bone in spinal tuberculosis were selected as none-PRP group (16 cases).The bone transplanted fusion time,operation time,treatment time,intraoperative blood loss,postoperative Oswestry index (ODI),VAS score,CRP,ESR after 1 week to 2 months,complication incidence of patients were recorded and analyzed.Results All the patients' spinal tuberculosis in PRP group and none-PRP group were cured.The bone fusion time,average operation time the average time of treatment,postoperative 1 weeks to 2 months hs-CRP,ESR value,and complication rate in PRP group were shorter or lower than those in none-PRP group,ODI scores in PRP group was higher than that in none-PRP group,the differences were statistically significant (P ＜ 0.05).The amount of bleeding and postoperative pain VAS score (not including donor) in two groups were compared,the differences were not statistically significant (P ＞ 0.05).Conclusion Autologous PRP and artificial bone mixture compares with ilium in spinal tuberculosis after grafting bone fusion has obvious advantages.Its application not only shortens the operation time,but also effectively avoid the donor bone pain and other complications.Most notably,the PRP-artificial bone can substantially shorten the time of bone graft fusion and provide an effective and reasonable treatment for spinal tuberculosis.%目的 探讨自体富血小板血浆(PRP)与人工骨混合物在脊柱结核病灶清除后植骨融合术中的临床应用及疗效.方法 选择青海大学附属医院2013年3月～2016年3月青海本地脊柱结核患者32例,采用自体PRP与人工骨混合物进行脊柱结核病灶清除后的植骨融合术组为PRP组(16例),采用自体髂骨进行植骨融合为非PRP组(16例).记录并分析患者术后VAS评分,术后Oswestry功能障碍指数(ODI)评分、并发症发生率、手术时间、术中出血量、植骨融合时间、术后1周～2个月超敏C反应蛋白(hs-CRP)、红细胞沉降率(ESR).结果 PRP组和非PRP组患者的脊柱结核治疗均达到治愈.PRP组患者植骨融合时间、手术时间、治疗时间、术后1周～2个月CRP、ESR数值及并发症发生率均短于或低于非PRP组,术后ODI评分高于非PRP组,差异有统计学意义(P＜0.05).而两组患者术中出血量及术后疼痛VAS评分(不包括供骨区)比较,差异无统计学意义(P＞0.05).结论 自体PRP与人工骨混合物相较自体髂骨,在脊柱结核病灶清除后植骨融合术中具有明显优势,其应用不仅明显缩短了手术时间,而且有效避免了供骨区取骨后疼痛及其他并发症.最为明显的是,PRP-人工骨混合材料的植骨应用可大量缩短植骨融合的时间,为脊柱结核提供了有效且合理的治疗方法.