一期前路病灶清除植骨内固定术治疗颈椎布鲁杆菌性脊柱炎  

Single- stage anterior debridement and graft internal fixation for the treatment of cervical Brucella spondylitis

作　　者：章鹏[1] 杨新明[2] 

机构地区：[1]河北北方学院研究生院外科,张家口075000 [2]河北北方学院附属第一医院骨科,张家口075000

出　　处：《中国矫形外科杂志》2015年第1期26-30,共5页Orthopedic Journal of China

基　　金：2013年河北省医学重点学科跟踪项目(编号:GL201321);2013年河北省省级重大医学科研课题(编号:zd2013049);张家口市2010年科学技术与发展指令计划资助项目(编号:1012010D-1)

摘　　要：[目的]探讨颈椎布鲁杆菌性脊柱炎有效的外科治疗方法及临床效果。[方法]对2002年1月~2012年1月期间,经临床及实验室检查确诊且具有手术指征的颈椎布鲁杆菌性脊柱炎的患者32例采用一期前路病灶清除植骨内固定术治疗。男21例,女11例;年龄40~69岁,平均49.5岁。病程3~6个月,平均4.5个月。2个椎体受累24例,3个椎体受累8例。均合并不同程度神经功能损伤。术后末次随访行疼痛视觉模拟评分（VAS）、日本骨科协会评分（JOA）、临床疗效评价以及X线片、MRI影像学观察。[结果]术后32例均获随访,随访时间24~48个月,平均32个月。术后椎体间植骨融合,无断钉、断板、复发病例。术前及末次VAS评分为（9.0±0.6）、（1.0±0.7）,JOA评分为（8.0±1.6）、（14.9±1.7）,术后VAS评分和JOA评分均较术前显著改善,差异有统计学意义（P〈0.05）。临床疗效评价：术后均无加重患者,末次随访优良率为100%。末次随访复查X线片及MRI未发现复发。[结论]一期前路病灶清除植骨内固定术治疗颈椎布鲁杆菌性脊柱炎,可以控制病变部位发展,缓解疼痛,重建颈椎稳定性,恢复神经功能,临床效果满意。[Objective] To determine an effective surgical treatment for cervical Brucella spondylitis and evaluate the clinical results. [Methods] Thirty- two cases of cervical Brucella spondylitis treated using single- stage anterior debridement and graft internal fixation between January 2002 and January 2012 were included in the study. The data on clinical and laboratory diagnoses and surgical indications in these patients were extracted. The patients included 21 men and 11 women（ mean age,49. 5years; range,40 ~ 69 years）. Duration ranged from 3 to 6 months,with an average of 4. 5 months. Additionally,24 and 8 patients had involvement of 2 and 3 vertebrae,respectively. There were varying degrees of neurological damage. The Visual Analogue Scale（ VAS） score and Japanese Orthopaedic Association（ JOA） score were determined,and clinical evaluation,radiography,and magnetic resonance imaging（ MRI） were performed. [Results] The 32 patients were followed up for 24 to 48 months,with a mean of 32 months. No adverse effects were observed after the operation,such as interbody fusion, broken nails,broken boards,and relapse. The preoperative and last follow- up VAS scores were（ 9. 0 ± 0. 6） and（ 1. 0 ± 0. 7） and JOA scores were（ 8. 0 ± 1. 6） and（ 14. 9 ± 1. 7）,respectively,and the differences were statistically significant（ P 〈 0. 05）.On clinical evaluation after the operation,the outcome in patients with no aggravation was good. The last follow- up radiography and MRI found no recurrence. [Conclusion] The abovementioned procedure controlled the development of lesions,provided pain relief,helped in providing cervical spine stability,and restored nerve function to obtain satisfactory clinical results.

关 键 词：布鲁杆菌性脊柱炎 颈椎 手术 临床治疗 

分 类 号：R516.7[医药卫生—内科学]