一期后路病灶清除、椎间植骨治疗腰椎布氏杆菌性脊柱炎  

Posterior Radical Debridement Intervertebral Fusion and Internal Fixation for the Treatment of Lumbar Brucella Spondylitis

作　　者：贺欣[1] 张嘉男[1] 刘继军[1] 王文涛[1] 孟羿彬[1] 黄云飞[1] 王欣文 吴起宁[1] 郝定均[1] 

机构地区：[1]西安交通大学医学院附属红会医院脊柱外科腰椎病区,陕西西安710054

出　　处：《实用骨科杂志》2018年第2期108-111,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨一期后路病灶清除、椎间植骨融合内固定治疗腰椎布氏杆菌性脊柱炎的安全性及临床疗效。方法回顾性研究2010年1月至2014年1月,采用单纯后路病灶清除、椎间植骨及椎弓根钉—棒系统内固定治疗腰椎布氏杆菌性脊柱炎16例,男10例,女6例;年龄19~66岁,平均(40.6±15.0)岁。病灶累及椎体数目均为单节段。所有患者入院时均有腰背部局部疼痛,其中13例术前存在持续发热。终末随访时行标准布氏杆菌凝集法、X线及CT检查,评估布氏杆菌性脊柱炎治愈及融合情况。结果 16例患者均完成随访。平均手术时间100~140 min,平均(122±15)min;术中出血量300~650mL,平均(482±118)mL。术中及围手术期无死亡,无出现神经压迫症状的病例。13例术前存在持续发热的患者,术后10d均未再出现明显发热。随访时间12~47个月,平均随访(18.6±5.7)个月。术后10d患者疼痛视觉模拟评分(visual analogue scale,VAS)由术前平均(6.60±0.89)分改善至(2.40±0.63)分,末次随访VAS评分平均为(1.70±0.38)分。Oswestry功能障碍指数问卷表(oswestry disability index,ODI)评分由术前的平均(77±4)分改善为终末随访时(12±5)分。末次随访未见布氏杆菌原位复发且所有患者植骨均成功融合。结论对于单节段受累的腰椎布氏杆菌性脊柱炎,单纯后路手术是一种安全、有效的治疗方式;应用后路病灶清除、椎间植骨融合内固定术,以较小的创伤加快疾病的恢复、重建病椎的稳定性。Objective To evaluate the safety and efficacy of posterior radical debridement,intervertebral fusion and internal fixation for the treatment of lumbar brucella spondylitis.Methods There were 16 cases（10 males,6 females）underwent posterior approach radical debridement,intervertebral fusion and internal fixation for the treatment of lumbar brucella spondylitis from January 2010 to January 2014.The average age was（40.6±15）years（19 to 66 years）.All patients had single segment infection and had lower back pain.13 of them had persistent fever.Visual analogue scale（VAS）and Oswestry Disability Index questionnaire（ODI）were evaluated before operation andin the final follow-up.At the final follow-up,all patients underwent standard Brucella agglutination test,X-ray and computed tomography（CT）to evaluate clinical outcomes.Results 16 patients were followed up for 12 to 47 months（18.6±5.7）months.The operation time was 100 to 140 minutes（122±15）mins;blood loss was 300 to 650 mL（482±118）mL.There was nointraoperative and perioperative death,and nerve compression symptoms.13 cases with preoperative feverdid not have a fever at 10 days after operation.Compared with pre-operation,VAS and ODI were significant improved.At the final follow-up,All the patients were cured and got intervertebral fusion.Conclusion Posterior radical debridement,intervertebral fusion and internal fixation for the treatment of lumbar Brucella spondylitis is a safe and effective treatment.

关 键 词：腰椎 布氏杆菌性脊柱炎 后路 手术治疗 

分 类 号：R681.55[医药卫生—骨科学]