经椎间孔入路镜下病灶清除加置管冲洗治疗单节段腰椎感染  

Treatment of single-segment lumbar vertebra infection by endoscopic focus debridement and catheter irrigation via interforaminal approach

作　　者：翟凯 李延坤 马振 郭翔 田云虎[2] ZHAI Kai;LI Yankun;MA Zhen;GUO Xiang;TIAN Yunhu(Department of Surgery,Weifang Medical University,Weifang 261053,China;Department of Spine Orthopaedics,the Affiliated Hospital of Weifang Medical University)

机构地区：[1]潍坊医学院外科学教研室,山东潍坊261053 [2]潍坊医学院附属医院脊柱外科

出　　处：《潍坊医学院学报》2020年第4期285-288,305,共5页Acta Academiae Medicinae Weifang

摘　　要：目的探讨经椎间孔入路镜下病灶清除加置管冲洗治疗单节段腰椎感染的临床疗效。方法选取2015年2月~2018年12月于潍坊医学院附属医院脊柱外科行椎间孔镜手术治疗的18例单节段腰椎感染的病例,其中腰椎布鲁氏杆菌感染5例、腰椎结核杆菌感染5例、腰椎非特异性感染8例(腰椎后路术后椎间隙感染4例)。记录手术前后的血沉(ESR)、C反应蛋白(CRP),定期复查磁共振,采用视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和改良MacNab标准评估患者临床疗效。结果术后腰腿痛均明显缓解,术中及术后均未出现严重并发症。平均随访(10.11±1.91)个月,与术前相比,术后3d、1个月、3个月及末次随访时ESR、CRP、VAS评分均显著降低,差异有显著性(P<0.05);术后1个月、3个月及末次随访时ODI指数明显降低,差异有显著性(P<0.05)。定期复查磁共振提示病灶及脓肿逐渐缩小,末次随访时,参考改良的MacNab疗效标准评定为优15例,良3例,优良率100%.结论经皮椎间孔镜技术治疗腰椎感染,创伤小、效果好,是一种安全、可靠的治疗方法。Objective To explore the clinical effect of focal debridement and catheter irrigation through interforaminal approach in the treatment of single-segment lumbar vertebra infection.Methods From February 2015 to December 2018,18 cases of single segment lumbar vertebra infection were treated by transforaminal endoscope in the spinal surgery department of the Affiliated Hospital of Weifang Medical University.Among them,there were 5 cases of brucellosis infection,5 cases of tuberculosis infection and 8 cases of non-specific infection of lumbar spine(4 cases of post-operative intervertebral space infection of lumbar spine).Blood sedimentation(ESR),C-reactive protein(CRP) were recorded before and after the operation,and magnetic resonance was reviewed regularly.Visual analogue scale(VAS),Oswestry dysfunction index(ODI) and modified MacNab standards were used to evaluate the clinical efficacy of the patients.Results The pain of lumbago and leg was relieved obviously after operation,and no serious complications occurred during and after operation.Mean follow-up period(10.11±1.91) months,Compared with pre-operation,ESR,CRP,VAS scores decreased significantly at 3 days,1 month,3 months and last follow-up,the difference is statistically significant(P<0.05),and ODI index decreased significantly at 1 month,3 months and at last follow-up,the difference was statistically significant(P<0.05).Regular magnetic resonance examination showed that the focus and abscess were gradually reduced,at the last follow-up,according to the modified MacNab criteria,15 cases were excellent,3 cases were good,and the excellent and good rate was 100%.Conclusion Percutaneous interbody foramentoscopy is a safe and reliable method for the treatment of lumbar vertebra infection with little trauma and good effect.

关 键 词：腰椎感染 椎间孔镜 病灶清除 置管冲洗 

分 类 号：R681.57[医药卫生—骨科学]