Quadrant系统下经多裂肌间隙入路治疗布鲁杆菌性脊柱炎的效果  

CLINICAL EFFECT OF TRANS-MULTIFIDUS APPROACH UNDER THE GUIDANCE OF QUADRANT SYSTEM IN TREATMENT OF BRUCELLOSIS SPONDYLITIS

作　　者：王文轩 王炳武[1] 潘洪发 刘伟强[2] WANG Wenxuan;WANG Bingwu;PAN Hongfa;LIU Weiqiang(Graduate Student Department, Weifang Medical University, Weifang 261000, China)

机构地区：[1]潍坊医学院研究生学院,山东潍坊261000 [2]潍坊市人民医院脊柱外科

出　　处：《青岛大学医学院学报》2017年第5期572-574,579,共4页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的探讨Quadrant系统下经多裂肌间隙及横突间入路行椎间隙病灶清除并置管引流治疗布鲁杆菌性脊柱炎的效果。方法选取布鲁杆菌感染性脊柱炎病人中具有手术指征者24例,其中病灶位于腰椎18例,胸椎6例。术前给予药物治疗;术中选择经多裂肌间隙及横突间入路,自椎间孔外缘行椎间病灶清除术,并置管冲洗引流;术后进行椎间隙缓慢、持续冲洗1周,联合药物治疗。术后每3个月随访1次,检测病人血细胞沉降率、C反应蛋白等指标,行X线、CT及MR等影像学检查,随访至病人临床治愈。结果随访3~18个月,24例病人均临床治愈,术后切口及引流口愈合良好,无窦道形成。术后Oswestry功能障碍指数低于术前,差异有显著性(F=143.83,P<0.05)。末次随访采用改良Macnab疗效评定标准评价疗效,优19例,良5例。结论 Quandrant系统下经多裂肌间隙及横突间入路病灶清除并置管引流术为治疗布鲁杆菌性脊柱炎的有效方法。Objective To investigate the clinical effect of trans-multifidus and intertransverse approaches under the guidance of the Quadrant system in the treatment of brucellosis spondylitis by intervertebral debridement and catheter drainage.Methods A total of 24 patients with brucellosis spondylitis who were admitted to our department and had surgical indications were enrolled,among whom 18 had lesions in the lumbar vertebra and 6 had lesions in the thoracic vertebra.Medication was given before treatment;the trans-multifidus and intertransverse approaches were selected during surgery,intervertebral debridement was performed along the outer edge of the intervertebral foramen,and a drainage catheter was placed.The intervertebral space was flushed slowly and continuously for 1 week,and medication was given at the same time.The patients were followed up once every 3 months after surgery;blood parameters such as erythrocyte sedimentation rate and C-reactive protein were measured,and imaging examinations including X-ray,CT,and MR were performed;the patients were followed up to clinical cure.Results The patients were followed up for 3-18 months,and all of them achieved clinical cure and good healing of surgical incision and drainage opening without the formation of deep blind fistula.All patients had a significant reduction in Oswestry Disability Index after surgery（F=143.83,P〈0.05）.The modified MacNab efficacy evaluation criteria were used during the last follow-up to evaluate clinical outcome;of all patients,19 had an excellent outcome and 5 had a good outcome.Conclusion Intervertebral debridement and catheter drainage via the trans-multifidus and intertransverse approaches under the guidance of Quadrant system are effective methods for the treatment of brucellosis spondylitis.

关 键 词：脊柱炎 布鲁杆菌属 外科手术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]