38例伴有神经损害的布病性脊椎炎的观察  

Surgical outcomes of 38 cases of Brucellar spondylitis with nervous lesion

作　　者：孟宪勇[1] 杨新明[1] 章鹏[1] 胡长波[1] 

机构地区：[1]河北北方学院附属第一医院骨外科,河北张家口075000

出　　处：《中国矫形外科杂志》2015年第5期393-401,共9页Orthopedic Journal of China

摘　　要：[目的]探讨伴有神经损害的布鲁杆菌病性脊椎炎有效的外科治疗方法且评价手术策略的临床效果。[方法]经确诊且符合手术入选标准的38例患者,采用彻底清除病灶,解除脊髓或神经根受压,同时行植骨及后路椎弓根内固定重建脊柱稳定性,术后1、3、6、12个月进行随访,临床评价包括:疼痛评分、神经功能Frankel分级比较、临床疗效评价以及X线、MRI影像学观察的盲测评价。采用SPSS 15.0统计软件包进行分析;计量资料数据以均数±标准差表示。多组间比较用重复测量方差分析,若有统计学差异,则术后各时间点与治疗前的多重比较采用q检验:计数资料用x2检验。检验水准取值0.05。[结果]疼痛评分显示,术后各时间点分值与术前比较差异有统计学意义(P<0.05)。神经功能损伤手术前后分级比较显示,随着时间推移,所有患者术前神经损伤症状和行走能力术后均得到改善。改善率100%,痊愈率91.03%,各时间点痊愈率与改善率比较以及各自与前一时间段比较差异有统计学意义(P<0.05)。影像学观察的盲测评价显示,影像学指标评分值逐渐增加,术后各时间点与术前比较差异有统计学意义(P<0.05)。[结论]对于伴有神经损害的BS患者,手术治疗作为综合治疗的一部分,能够解除疼痛,恢复脊柱稳定性,解除神经压迫,恢复神经功能,早期康复有明显优势,是一种较为理想的治疗方式。[Objective] This study aimed to discuss the effective surgical approach for Brncellar spondylitis with nervous lesion and evaluate the clinical outcome. [ Methods] The focus of infection was totally removed, and the spine cord and nerve root compression was relieved. At the same time of bone grafting, posterior pedicle internal fixation was performed in 38 ca- ses. The cases were followed up at the 1st, 3rd, 6th and 12th month after surgery. The pain score, Frankel＇ s nerve function grad- ing, clinical outcome, and image results of X -ray and MRI were studied. All data were analyzed by SPSS 15.0. The results were expressed as mean± standard deviation. Comparison among groups was performed by analysis of variance. For statistical distribu- tion, the comparison was performed with use of q test. The enumeration data were analyzed by chi - square test and the size of test was 0. 05. [ Results] There were significant difference considering the pain score between each time point after surgery and before surgery （P 〈 0. 05） . The nerve injury and locomotor activity were gradually improved for all patients after surgery, with the improving rate 100% and recovery rate 91.03%, and the difference between different time points was significant （ P 〈 0.05）. From X - ray and MRI image, the imaging score gradually increased after operation, and the difference between differ- ent time points was significant （P 〈 0. 05 ） . [ Conclusion ] This combined surgical approach is effective for the treatment of Brucellar spondylitis with nervous lesion, which can relieve the pain, regain the stability of the spine, remove the compression to the nerve and regain the nerve function. This surgical approach has an obvious superiority for early convalescence.

关 键 词：布鲁杆菌病 脊柱炎 神经损害 手术治疗 

分 类 号：R687.3[医药卫生—骨科学]