经皮内镜下清创冲洗术治疗腰椎间隙非特异性感染  

Percutaneous endoscopic debridement and irrigation for non-specific infection of lumbar intervertebral space

作　　者：曹臣[1] 陈书连[1] 高延征[1] 艾进伟 张锴 王耀斌 刘利民 CAO Chen;CHEN Shu-lian;GAO Yan-zheng;AI Jin-wei;ZHANG Kai;WANG Yao-bin;LIU Li-min(Department of Spine and Spinal Cord Surgery,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院脊柱脊髓外科,郑州450003

出　　处：《中国矫形外科杂志》2021年第5期408-412,共5页Orthopedic Journal of China

摘　　要：[目的]探讨经皮内镜下清创冲洗术治疗腰椎间隙非特异性感染的临床疗效。[方法]回顾性分析2016年9月~2019年9月在本科行经皮内镜下清创冲洗术治疗腰椎间隙非特异性感染的17例患者资料,其中男11例,女6例;年龄51~82岁,平均(66.94±9.37)岁;病变节段:L2/33例,L3/44例,L4/57例,L5S13例;7例患者有既往侵入性操作史。总结围手术期、随访与辅助检查结果。[结果]所有患者手术均顺利完成,无严重并发症。术后患者VAS评分和体温显著下降(P<0.05),至术后14 d患者疼痛基本消失,体温恢复正常或接近正常。随时间推移,患者改良ODI评分显著下降,而JOA评分显著增加(P<0.05)。至末次随访时,无原椎间隙感染复发。辅助检查方面,病理检查显示组织炎细胞浸润伴肉芽组织增生。17例患者中12例检出病原菌。随时间推移17例患者WBC、中性粒细胞分类、ESR和CPR均显著下降(P<0.05)。末次随访时MRI检查显示,病变椎间隙清晰,邻近椎体信号均匀,无混杂信号。[结论]经皮内镜下清创冲洗术是治疗腰椎间隙非特异性感染的有效方法,且手术创伤小,治疗效果可靠。[Objective]To explore the clinical efficacy of percutaneous endoscopic debridement and irrigation for non-specific lumbar intervertebral infections.[Methods]A retrospective analysis was conducted on the data of 17 patients who underwent percutaneous endoscopic debridement and irrigation for non-specific lumbar intervertebral infections in our department from September 2016 to September2019.Of them,11 males and 6 females aged 51~82 years with an average of (66.94±9.37) years.The infection involved L2/3in 3 cases,L3/4in 4 cases,L4/5in 7 cases and L5S1in 3 cases,and a history of previous invasive procedures was noted in 7 patients.The documents of perioperative period,follow-up and objective examinations were summarized.[Results]All patients had operation completed successfully without serious complications.The patient’s VAS score and body temperature continued to decrease significantly after the operation (P<0.05).By 14 days after the operation,the patient’s pain basically disappeared,and the body temperature returned to normal or nearly normal.The modified ODI score decreased significantly,while the JOA score increased significantly over time (P<0.05).To the last follow-up,infection recurrence in the original intervertebral space did not happen in anyone of them.In term of objective assay,the pathological examination showed tissue inflammatory cell infiltration and granulation tissue hyperplasia;pathogenic bacteria were detected in 12 of the 17 patients;whereas WBC,neutrophil classification,ESR and CPR in 17 patients decreased significantly over time (P<0.05).At the latest follow-up,MRI showed that the intervertebral space of the lesion was clear,the signal of the adjacent vertebral body was uniform without confounding signals.[Conclusion]Percutaneous endoscopic debridement and irrigation are effective method for the treatment of non-specific lumbar intervertebral infections,with small surgical trauma and reliable therapeutic effects.

关 键 词：腰椎间隙非特异性感染 内镜术 病灶清除术 临床疗效 

分 类 号：R681.57[医药卫生—骨科学]