颈椎布鲁杆菌性脊柱炎合并硬膜外脓肿的手术治疗  

Surgical treatment of cervical brucellar spondylitis associated with epidural abscess

作　　者：杨成伟[1] 蓝旭[1] 李松凯[1] 王世勇[1] 高杰[1] 

机构地区：[1]兰州军区总医院脊柱外科,甘肃730050

出　　处：《脊柱外科杂志》2017年第5期257-261,共5页Journal of Spinal Surgery

摘　　要：目的探讨颈椎布鲁杆菌性脊柱炎合并硬膜外脓肿的诊断及外科治疗。方法 2012年1月—2015年4月,本院采用前路一期病灶清除植骨融合内固定术治疗12例颈椎布鲁杆菌性脊柱炎合并硬膜外脓肿患者。病变侵犯节段:C3/C4 1例,C4/C5 2例,C5/C6 6例,C6/C7 3例。术前神经功能美国脊髓损伤协会(ASIA)分级:B级1例,C级2例,D级7例,E级2例。术前日本骨科学会(JOA)评分为(9.83±4.45)分。术前红细胞沉降率(ESR)为(34.67±18.25)mm/h。术前所有患者规范抗感染治疗>1周,术后继续抗感染治疗6~12个月。观察患者术后疗效及植骨融合情况。结果所有手术均顺利完成,无感染播散。随访12~30个月,平均16.6个月,切口均一期愈合。术后1年随访时,B级和C级各1例患者恢复至D级,余C级1例和D级7例患者恢复至E级。术后1年随访时JOA评分改善至(15.50±2.02)分,与术前相比差异有统计学意义(P<0.05)。术后3个月ESR为(7.58±5.32)mm/h,与术前相比差异有统计学意义(P<0.05)。末次随访时,所有患者均获得植骨融合,无内固定相关并发症发生,无布鲁杆菌性脊柱炎复发。结论颈椎布鲁杆菌性脊柱炎合并硬膜外脓肿较为少见,容易误诊,对可疑病例应进行血清学排查。在规范抗感染治疗的基础上,行前路病灶清除植骨融合内固定术可获得良好的临床疗效。Objective To explore the method for diagnosis and surgical management of cervical brucellar spondylitis associated with epidural abscess. Methods From January 2012 to April 2015,12 cervical brucellar spondylitis associated with epidural abscess patients were treated with anterior debridement,bone fusion and internal fixation. The lesion invasion involved C3/C4 in 1 case,C4/C5 in 2 cases,C5/C6 in 6 and C6/C7 in 3. Based on the preoperative American Spinal Injury Association（ASIA）classification,Grade B was seen in 1 case,Grade C in 2 cases,Grade D in 7 cases and Grade E in 2 cases. The preoperative Japanese Orthopaedic Association（JOA） score was 9.83±4.45. The preoperative erythrocyte sedimentation rate（ESR） was（34.67±18.25）mm/h. Anti-brucellosis therapy was given for at least 1 week before the operation,and lasted for 6-12 months postoperatively. The clinical effect and bone fusion condition were observed. Results All the operations were successfully completed without spread of infection. The follow-up period was 12-30 months,mean 16.6 months,and all the incisions achieved primary healing. Neurological function of all patients recovered,grade B,C to grade D in 1 respectively,grade C to E in 1 case and grade D to E in 7 cases grade E. The JOA score improved to 15.50±2.02 at 1 years after the operation,and the difference was statistically significant（P〈0.05）. The ESR was（7.58±5.32）mm/h at postoperative 3 months;compared with that of pre-operation,the difference was statistically significant（P〈0.05）. At the final follow-up,all patients received bone graft fusion without complications associated with internal fixation and no recurrence of brucellosis. Conclusion Cervical brucellar spondylitis associated with epidural abscess is a very rare disease,thus being easy to misdiagnose. It is important to identify a patient with a history of potential exposure using laboratory studies. On the basis of standard anti-brucellosis chemotherapy,anterior debridement,internal fixation and bone fus

关 键 词：布鲁杆菌病 脊柱炎 硬膜外脓肿 脊柱融合术 内固定器 

分 类 号：R681.51[医药卫生—骨科学]