后路病灶清除植骨内固定治疗胸腰椎化脓性脊柱炎的疗效研究  

Debridement,spinal fusion,and internal fixation through a posterior approach for treatment of pyogenic spondylodiscitis:a clinical observational study

作　　者：贾小武 刘昌昊 施建党[2] 牛宁奎[2] 丁惠强[2] JIA Xiao wu;LIU Chang hao;SHI Jian dang;NIU Ning kui;DING Hui qiang(Ningxia Medical University,Yinchuan 750004,China;Department of Spinal Orthopaedics,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学,宁夏银川750004 [2]宁夏医科大学总医院脊柱骨科,宁夏银川750004

出　　处：《骨科》2020年第2期100-105,共6页ORTHOPAEDICS

基　　金：国家自然科学基金(81760399)。

摘　　要：目的评价后路病灶清除植骨内固定治疗胸腰椎化脓性脊柱炎的临床疗效。方法对2012年6月至2019年6月在宁夏医科大学总医院采用后路病灶清除植骨内固定治疗的23例化脓性脊柱炎病人的临床资料进行回顾性分析,其中男16例,女7例,年龄为(59.36±17.33)岁(32~88岁)。病变位于腰椎者14例,位于胸腰段者5例,位于胸椎者4例。分析术前临床症状、体征、实验室检查及影像学资料。采用红细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C reactive protein,CRP)评价病人手术前后的感染控制情况,疼痛视觉模拟量表(visual analogue scale,VAS)评价病人手术前后局部疼痛缓解情况,美国脊柱损伤协会(American Spinal Injury Association,ASIA)运动功能分级评价手术前后神经功能改善,病变椎体Cobb角评价病人脊柱后凸矫正,X线片、CT扫描、MRI检查评价病灶融合情况。结果病人手术时间为(177.46±49.13)min(120~260 min),术中出血量为(371.78±94.14)ml(200~600 ml),随访时间为(25.82±12.82)个月(12~48个月),截至末次随访没有复发。病人术后1、3、6个月的ESR分别为(41.09±29.63)mm/h、(18.65±16.21)mm/h、(10.57±3.04)mm/h,CRP分别为(19.15±20.29)mg/L、(4.67±5.45)mg/L、(2.25±0.47)mg/L,术后6个月的ESR及CRP均降至正常。术后1、3、6个月VAS评分分别为(3.74±0.96)分、(2.43±0.66)分、(1.21±0.73)分,明显低于术前,差异均有统计学意义(P均<0.05)。术后病人神经功能较术前恢复,13例恢复至E级、2例恢复至D级。术后1、3个月的Cobb角分别为8.83°±2.33°、7.61°±2.04°,与术前Cobb角(17.48°±7.37°)比较明显恢复,差异均有统计学意义(P均<0.05)。术后1年X线片及CT提示22例病人已融合,1例病人融合欠佳。所有病人均未出现严重并发症。结论后路病灶清除植骨内固定可以有效治疗胸腰段化脓性脊柱炎。Objective To evaluate the clinical and radiological outcome of debridement,spinal fusion and internal fixation through a posterior approach in the surgical management of patients with pyogenic spondylodiscitis.Methods From June 2012 to June 2019,23 patients(16 males and 7 females)with age of(59.36±17.33)years(32 88 years)suffering from pyogenic spondylodiscitis were included.All patients received debridement of the infected intervertebral disc space,internal fixation and spinal fusion.The lesion was located in lumbar spine in 14 patients,thoracolumbar in 5 patients,and thoracic spine in 4 patients.Preoperative clinical symptoms,signs,laboratory tests and imaging data were analyzed.Erythrocyte sedimentation rate(ESR)and C reactive protein(CRP)were used to evaluate the infection control of patients preoperation and postoperation.Local pain relief preoperation and postoperation was evaluated by visual analogue scale(VAS).The neurological function of patients preoperation and postoperation was evaluated by American Spinal Injury Association(ASIA).The Cobb angle was used to evaluate the correction of kyphosis in patients.X ray,CT and MRI were used to evaluate the fusion of lesions.Results The operation time was(177.46±49.13)min(120 260 min),intraoperative blood was(371.78±94.14)ml(200 600 ml).All patients were followed up for(25.82±12.82)months(12 48 months),and there was no recurrence until the last follow up.The postoperative ESR at 1st,3rd,and 6th month was(41.09±29.63),(18.65±16.21)and(10.57±3.04)mm/h,respectively.The postoperative CRP at 1st,3rd,and 6th month was(19.15±20.29),(4.67±5.45)and(2.25±0.47)mg/L,respectively.ESR and CRP decreased to normal at the 6th month after operation.The postoperative VAS scores of pain at 1st month(3.74±0.96),3rd month(2.43±0.66)and 6th month(1.21±0.73)were all significantly decreased when compared with preoperative scores(all P<0.05).The neurological function of patients after operation was better than that before operation:13 cases were restored to ASIA E and 2 was

关 键 词：后路病灶清除植骨内固定 胸腰椎 化脓性脊柱炎 疗效 

分 类 号：R687.3[医药卫生—骨科学]