单侧与双侧后路开窗、病灶清除、植骨融合术治疗腰骶椎布鲁杆菌性脊柱炎  

Unilateral or bilateral posterior fenestration debridement and bone graft fusion for the treatment of lumbosacral brucellosis spondylitis

作　　者：买尔旦·买买提[1] 白凤周 木拉德·买尔旦 徐韬[1] 亚克甫·阿不力孜 祖力亚尔·木拉吾东 西尔艾力·赛买提 伊尔夏提·克力木 梁卫东[1] 荀传辉[1] 张健[1] 曹锐[1] 邓强[1] 盛伟斌[1] Mardan·mamat;Bai Fengzhou;Muradil·mardan;Xu Tao;Yakup·abliz;Zuliyar·mollawudon;Xirali·samat;Erxat·kerem;Liang Weidong;Xun Chuanhui;Zhang Jian;Cao Rui;Deng Qiang;Sheng Weibin(Department of Spinal Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Shandong Chengwu County People's Hospital,Chengwu 274200,China;Department of Clinical Medicine,Medical College of Tongji University,Shanghai 200092,China;the Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院,乌鲁木齐830054 [2]山东成武县人民医院,274200 [3]同济大学医学院临床医学系,上海200092 [4]新疆医科大学第六附属医院,乌鲁木齐830054

出　　处：《中华骨科杂志》2021年第20期1459-1466,共8页Chinese Journal of Orthopaedics

基　　金：新疆维吾尔自治区科技计划项目(201323127)。

摘　　要：目的分析单侧与双侧开窗、病灶清除、植骨融合内固定术治疗腰骶椎布鲁杆菌性脊柱炎的临床疗效。方法回顾性分析2013年6月至2019年6月行一期后路开窗、病灶清除、植骨融合术治疗的腰骶椎布鲁杆菌性脊柱炎患者48例纳入研究。按照手术方式分为两组,单侧开窗组:行一期后路单侧开窗、病灶清除、植骨融合内固定手术27例,男21例,女6例,年龄23~71岁。双侧开窗组:采用一期后路双侧开窗、病灶清除、植骨融合内固定术21例,男16例,女5例,年龄26~58岁。观察指标包括手术时间、术中出血量、腰部疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(the Oswestry Index,ODI)及日本骨科协会评分(Japanese Orthopaedic Association Scores,JOA)评分、C-反应蛋白、红细胞沉降率等,通过影像学检查评估内固定装置有无松动、断裂,使用Bridwell分级标准评价植骨融合情况,以及术后相关并发症情况。结果所有患者均顺利完成手术,术中病变组织送病检,结果均诊断为布鲁杆菌病。两组术前一般情况无统计学差异(P>0.05)。术后所有患者均获得随访,随访时间(23.7±6.3)个月(范围12~48个月)。两组患者术后各随访时间点C-反应蛋白、红细胞沉降率、VAS评分、ODI及JOA评分均较术前明显改善(P<0.05)。单侧开窗组手术时间、术中出血量分别为(120.5±34.1)min、(214.4±150.2)ml,双侧开窗组为(187.1±30.3)min、(455.8±250.5)ml,差异均有统计学意义(t_(手术时间)=8.123,t_(术中出血量)=2.962,P<0.05)。组间相同时间点C-反应蛋白、红细胞沉降率、VAS评分、ODI及JOA评分的差异均无统计学意义(P>0.05)。双侧开窗组中1例患者术后半个月出现切口感染,行清创引流术后痊愈。两组植骨融合时间的差异无统计学意义(t=0.542,P>0.05),末次随访时均完全融合。结论单侧与双侧开窗、病灶清除、植骨融合内固定术治疗腰骶椎布鲁杆菌性�Objective To analyze the application and clinical efficacy of one-stage unilateral or bilateral fenestration,debridement,interbody fusion combined with posterior internal fixation for the treatment of lumbosacral brucellosis spondylitis.Methods All patients with lumbosacral brucellosis spondylitis were retrospectively analyzed,who underwent fenestration,debridement,interbody fusion combined with posterior internal fixation from June 2013 to June 2019.A total of 48 patients were enrolled in this study.According to the surgical method,they were divided into two groups.Unilateral fenestration group:27 cases of one-stage posterior unilateral fenestration,debridement,interbody fusion combined with posterior internal fixation were performed,21 males and 6 females,aged 23-71 years;Bilateral fenestration group:21 cases of one-stage posterior bilateral fenestration,debridement,interbody fusion combined with posterior internal fixation were performed,aged 26-58 years.There were 16 males and 5 females.The preoperative and postoperative clinical symptoms,neurological function,C-reactive protein,the surgery duration time,the blood loss,and erythrocyte sedimentation rate were observed.The internal fixation device was evaluated for looseness or fracture by imaging examination.The Bridwell classification criteria were used to evaluate the bone graft fusion.Postoperative complications were also assessed.Results All patients completed the operation successfully,and the diseased tissues were sent for pathological examination during the operation,and all of them were diagnosed as brucellosis.All patients were followed up for 12-48 months(mean 23.7±6.3 months).C-reactive protein,erythrocyte sedimentation rate,Visual Analogue Scale(VAS),Oswestry Disability Index(ODI)and Japanese Orthopaedic Association Scores(JOA)were significantly improved in both groups at different time points after operation.There was no significant difference in the general condition before operation between the two groups(P>0.05).The mean operation time and mea

关 键 词：腰椎 骶骨 布鲁杆菌病 感染 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]