一期后路病灶清除、横突间植骨、钉棒系统固定治疗腰椎布氏杆菌性脊柱炎的近中期随访  

Mid-term follow-up of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation for brucella spondylitis of the lumbar spine

作　　者：张培楠[1] 杨新明[1] 薛广 ZHANG Pei-nan;YANG Xin-ming;XUE Guang(Orthopedic Department of The First Hospital Affiliated to Hebei North University,Zhangjiakou,075000, China;Graduate Department of Hebei North University,Zhangjiakou,075000, China)

机构地区：[1]河北北方学院附属第一医院骨科 [2]河北北方学院研究生部,河北张家口075000

出　　处：《海南医学院学报》2020年第9期659-663,共5页Journal of Hainan Medical University

基　　金：2018年度河北省卫生健康技术研究暨成果转化重点项目(zh2018014);2018年度河北省医学适用技术跟踪项目(GL2018074);2017年度张家口市市级计划(17120010D);2018年度河北北方学院校级科研项目(YB2018010)。

摘　　要：目的:探讨一期后路病灶清除、横突间植骨、钉棒系统固定治疗腰椎布氏杆菌性脊柱炎的近中期疗效。方法:选取本院收治的156例腰椎布氏杆菌性脊柱炎患者,按术式不同分为实验组(n=80)和联合组(n=76)。实验组给予一期后路病灶清除、横突间植骨、钉棒系统固定治疗,联合组采用一期前路病灶清除、横突间植骨联合后路内固定治疗,比较两组手术指标和临床疗效差异。结果:实验组手术时间、术中出血量、术后下地时间均少于联合组,差异具有统计学意义(P<0.05);治疗3、36个月后两组VAS评分、ODI指数、Cobb角和神经功能Frankel分级均明显改善(P<0.05),但同一时点两组间并无明显差异(P>0.05);治疗3、36个月后两组治疗优良率无明显差异(P>0.05),两组均未出现病灶复发,横突间植骨均愈合且钉棒系统固定良好。结论:一期后路病灶清除、横突间植骨、钉棒系统固定治疗腰椎布氏杆菌性脊柱炎疗效明显,手术时间短,对患者创伤小,具有临床推广价值。Objective: To investigate the short-term and med-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of brucella spondylitis of the lumbar spine.Methods: Totally 156 cases of brucella spondylitis of lumbar spine were selected and divided into experimental group(n=80)and combined group(n=76)according to different surgical methods.The experimental group was treated with one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation.The combined group was treated with one-stage anterior debridement and intertransverse process bone grafting combined with posterior internal fixation.The operative indexes and clinical effects were compared between the two groups.Result The operation time,intraoperative bleeding volume and time of walk after surgery in the experimental group were less than those in the combined group with statistical significance(P<0.05).VAS score,ODI index,Cobb angle and Frankel grade classification of nervous function in the two groups were significantly improved after 3 months and 36 months of treatment(P<0.05),but there was no significant difference between the two groups at the same time(P>0.05).There was no significant difference in the excellent and good rate between the two groups after 3 and 36 months of treatment(P>0.05).There was no recurrence of the lesion in both groups.The intertransverse process bone graft healed and the nail-rod system was well fixed.Conclusion: One-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation for treatment of Brucella spondylitis of lumbar spine are effective,with short operation time and less trauma,which are worthy of clinical promotion.

关 键 词：腰椎布氏杆菌性脊柱炎 病灶清除 横突间植骨 钉棒系统固定 疗效 

分 类 号：R687.3[医药卫生—骨科学]