前路手术治疗颈椎布鲁氏杆菌脊柱炎临床研究  

Clinical Study of Anterior Approach for the Treatment of Brucella Tpondylitis in Cervical Vertebrae

作　　者：费正奇 高应超 韩敬凛 陈波[1] FEI Zheng-qi;GAO Ying-chao;HAN Jing-lin;CHEN Bo(Orthopaedics Department, the 942 ndHospital of Joint Logistics Support Force of Chinese People ' s Liberation Army, Yinchuan 750001 ,Ningxia, China)

机构地区：[1]中国人民解放军联勤保障部队第九四二医院骨二科,宁夏银川750000

出　　处：《中国现代手术学杂志》2019年第1期30-34,共5页Chinese Journal of Modern Operative Surgery

基　　金：宁夏自然科学基金资助项目(NZ11236)

摘　　要：目的探讨临床较为罕见的颈椎布鲁氏杆菌性脊柱炎行前路手术的治疗效果。方法回顾性分析2005年2月～2017年12月本院诊治的19例颈椎布鲁氏杆菌性脊柱炎患者临床资料,患者术前均行X线片、 MRI检查,均接受前路病灶清除椎间植骨内固定术治疗,分析患者一般情况、治疗疗效、视觉模拟疼痛评分(visual analogue score, VAS)、日本骨科学会评分(Japanese Orthopaedic Association, JOA)及近期随访情况。结果 19例患者平均手术时间(52.52±10.62)min,术中出血量(282.01±8.32)ml,术中未见脊髓、神经及血管损伤,无食管气管瘘等并发症发生,术后切口均Ⅰ期愈合;术后3、6、12个月总有效率分别为89.47%、94.74%,100%,三者相较无明显差异(χ~2=2.111,P>0.05);与术前相较,术后12个月患者VAS评分明显降低,JOA评分明显升高(P<0.001);术后3～6个月随访发现患者植骨融合、病灶修复良好,颈椎稳定,术后7～12个月随访未发现颈椎滑脱、椎间植骨和内固定失败,脓肿及死骨等并发症。结论前路病灶清除Cage或钛笼植骨融合固定手术应用于颈椎布鲁氏杆菌性脊柱炎患者,可有效控制病变发展,缓解局部疼痛,重建颈椎稳定性,促进颈椎功能恢复,改善预后,且安全性好。Objective To investigate the curative effect of anterior approach for Brucella spondylitis in cervical vertebrae. Methods The clinical data of 19 patients with Brucella spondylitis in cervical vertebrae who were diagnosed and treated in our hospital from February 2005 to December 2017 were retrospectively analyzed. All patients underwent X-ray and MRI before operation. All patients underwent internal fixation with anterior radical debridement and interbody fusion. The surgical general condition,curative effect of treatment,visual analogue score( VAS),scores of Japanese Orthopaedic Association( JOA) and recent follow-up of all the 19 patients were analyzed. Results In the 19 patients,average operation time and intraoperative blood loss was( 52. 52 ± 10. 62) min and( 282. 01 ± 8.32) ml respectively. There was no spinal cord,nerve and vascular injury,nor esophagotracheal fistula during the surgery. Postoperative incision was healed at stage I. The total response rate at 3,6,and 12 months after surgery were 89.47%,94.74%,and 100% respectively(χ^2= 2.111,P> 0.05). The VAS scores significantly decreased, while the JOA scores significantly increased after surgery( P < 0. 001).It was found of the fair fusion of the bone graft,good lesions repair,and stable cervical vertebrae within 3 to 6 months follow-up. There was no cervical spondylolisthesis,failure of intervertebral bone grafting or internal fixation,abscess or dead bone during the 7 to 12 months follow-up. Conclusion The application of anterior approach with debridement and titanium mesh cage graft internal fixtion can effectively control the development of lesions,relieve pain,reconstruct cervical stability,promote function recovery,and improve prognosis with good safety for patients with Brucella spondylitis in cervical vertebrae.

关 键 词：脊柱炎 布鲁氏杆菌 颈椎 前路病灶清除椎间植骨内固定术 

分 类 号：R681.51[医药卫生—骨科学] R516.7[医药卫生—外科学]