前路病灶清除植骨联合钢板内固定治疗骶髂关节结核疗效分析

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摘要目的〓探讨一期前路病灶清除植骨融合联合骶髂关节钢板内固定在骶髂关节结核治疗中的临床疗效。方法〓回顾性分析2013年1月至2022年6月在新疆医科大学第八附属医院就诊并接受治疗的30例骶髂关节结核患者。根据Kim分型，Ⅲ型9例，Ⅳ型21例。根据手术方式分为对照组及研究组，其中对照组14例，男6例，女8例；年龄18~73岁，平均(54.57±16.93)岁；采用前路病灶清除植骨融合术。研究组16例，男5例，女11例；年龄25~72岁，平均(48.38±14.59)岁；采用前路病灶清除植骨加钢板内固定术，术后抗结核治疗12～18个月。比较两组手术时间、术中出血量等，统计两组植骨融合时间、术前及术后3个月红细胞沉降率(erythrocyte sedimentation rate，ESR)、C-反应蛋白(C-reactive protein，CRP)，术前、术后采用疼痛视觉模拟评分(visual analogue scale，VAS)、Majeed评分等进行疗效评价。结果〓所有患者均获得随访，随访时间12~18个月，平均随访(14.24±1.72)个月，30例骶髂关节结核患者均治愈。两组手术时间、植骨融合时间、部分承重下地时间比较，差异有统计学意义(P＜0.05)；VAS评分、Majeed评分等指标较术前均得到改善(P＜0.05)；术后1周VAS评分组间比较差异有统计学意义(P＜0.05)，术后3个月、术后6个月组间比较，差异无统计学意义(P＞0.05)；两组术后3个月、6个月Majeed评分比较，差异均有统计学意义(P＜0.05)。结论〓前路病灶清除植骨融合联合骶髂钢板固定具有操作简单、早期稳定骨盆、缩短植骨融合时间以及更好的提高骨盆功能等作用，是治疗骶髂关节结核的一种有效方法。

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	伊力亚尔·巴吐尔
	古甫丁
	唐伟
	马良
	米尔扎提·艾莎
	地里下提·阿不力孜

关键词 ：骶髂关节, 结核, 植骨融合, 钢板内固定

Abstract：Objective〓 To investigate the value of primary anterior defoliation and bone grafting combined with internal fixation of sacroiliac joint plate in the treatment of sacroiliac joint tuberculosis.Methods〓A retrospective analysis was performed on 30 patients with sacroiliac joint tuberculosis treated at the Eighth Affiliated Hospital of Xinjiang Medical University from January 2013 to June 2022.According to Kim's classification，there were 9 cases of type Ⅲ and 21 cases of type Ⅳ.The patients were divided into a control group and a study group based on the surgical approach.The control group comprised 14 patients，including 6 males and 8 females，with an age range of 18 to 73 years and a mean age of (54.57±16.93 )years.They underwent anterior lesion clearance and bone fusion.The study group consisted of 16 patients，with 5 males and 11 females，ranging in age from 25 to 72 years，with a mean age of (48.38±14.59)years.All patients underwent anterior debridement，bone grafting，and plate internal fixation，followed by anti-tuberculosis treatment for 12 to 18 months after surgery.The operation time，intraoperative blood loss，bone graft fusion time，erythrocyte sedimentation rate(ESR)，and C-reactive protein(CRP) levels before and 3 months after surgery were compared between the two groups.The visual analog scale(VAS) and Majeed score were used to evaluate the preoperative and postoperative effectiveness.Results〓All patients were followed up for a duration ranging from 12 to 18 months，with a mean follow-up of (14.24±1.72)months.All 30 cases of sacroiliac joint tuberculosis patients achieved cure.When comparing the two groups in terms of operation time，partial weight-bearing bone graft fusion time，and post-operative downtime，statistically significant differences were observed (P＜0.05).The VAS and Majeed grading index improved significantly from pre-operation to post-operation in both groups (P＜0.05).At 1 week post-operation，there was a significant difference in the VAS between the two groups (P＜0.05)，but no significant difference was found at 3 months and 6 months post-operation (P＞0.05).However，there were significant differences in Majeed scores between the two groups at 3 months and 6 months post-operation (P＜0.05).Conclusion〓 The use of anterior debridement and bone graft fusion combined with sacroiliac plate fixation is an efficacious approach for treating sacroiliac joint tuberculosis.This method boasts the advantages of a simplified surgical procedure，early stabilization of the pelvis，a shorter bone graft fusion time，and a significant improvement in pelvic function.

Key words： sacroiliac joint tuberculosis bone graft fusion plate internal fixation

基金资助:新疆艾滋病防控研究重点实验室开放课题项目(XJYS1706-2021005)
新疆维吾尔自治区“青年科技人才-乡村振兴”项目(WJWY-XCZX202220)

通讯作者: 地里下提·阿不力孜

作者简介: 伊力亚尔·巴吐尔(1992－ )，男，主治医师，新疆医科大学第八附属医院骨科，903389508@qq.com

引用本文:

伊力亚尔·巴吐尔，古甫丁，唐伟，马良，米尔扎提·艾莎，地里下提·阿不力孜. 前路病灶清除植骨联合钢板内固定治疗骶髂关节结核疗效分析[J]. 实用骨科杂志, 2024, 30(6): 490-.
Yiliyaer Batuer，Gu Fuding，Tang Wei，Ma Liang，Mierzhati Aisha，Dilixiati Abulizi. Clinical Effect Analysis of Anterior Debridement and Bone Grafting Combined With Plate Internal Fixation in the Treatment of Sacroiliac Joint Tuberculosis. sygkzz, 2024, 30(6): 490-.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2024/V30/I6/490

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