后路短节段内固定治疗腰椎布鲁杆菌性脊柱炎  

Surgical management of lumbar brucella spondylitis by posterior short-segment internal fixation

作　　者：黄智 辛大奇[1] 肖宇龙[1] 邢文华[1] 付裕[1] 赵岩[1] 李峰[1] 白贤明[1] 郑文凯 杨学军 祝勇[1] Huang Zhi;Xin Daqi;Xiao Yulong;Xing Wenhua;Fu Yu;Zhao Yan;Li Feng;Bai Xianming;Zheng Wenkai;Yang Xuejun;Zhu Yong(Spine Center,The Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,China;Department of Orthopaedics,The Affiliated People's Hospital of Inner Mongolia Medical University,Hohhot 010030,China)

机构地区：[1]内蒙古医科大学第二附属医院脊柱外科中心,呼和浩特010030 [2]内蒙古医科大学附属人民医院骨科,呼和浩特010030

出　　处：《中华骨科杂志》2021年第20期1467-1475,共9页Chinese Journal of Orthopaedics

基　　金：内蒙古医科大学"科技百万工程"资助项目(YKD2020KJBW(LH)023)。

摘　　要：目的探讨后路短节段内固定治疗腰椎布鲁杆菌性脊柱炎(brucella spondylitis,BS)的临床疗效。方法回顾性分析2014年1月至2019年6月收治34例布鲁杆菌性脊柱炎患者的病历资料,男22例,女12例;年龄(52.3±10.6)岁(范围35~72岁)。在规范化应用抗菌药物的基础上,均采用腰椎后路短节段内固定术,29例行单纯内固定、后外侧植骨融合术,5例行一期病灶清除、自体骨移植椎间融合内固定术。监测红细胞沉降率、C-反应蛋白、试管凝集试验(standard tube agglutination test,SAT)评估炎症控制情况。分析患者术前、术后1个月、术后3个月、术后6个月、术后1年及末次随访的影像学资料评估椎间融合情况,临床疗效评价采用疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分、改良MacNab标准及美国脊柱损伤协会(American Spinal Injury Association,ASIA)分级,同时记录手术相关并发症发生情况。结果34例患者手术时间为(104.64±16.72)min(范围65~145 min);平均住院时间为(16.49±7.41)d(范围7~38 d);术后随访时间平均为20.2个月(范围12~34个月)。末次随访时红细胞沉降率、C-反应蛋白均降至正常范围,SAT阴性。术后3个月时达到Bridwell融合标准Ⅱ级融合11例(32.35%),Ⅲ级融合23例(67.65%);术后6个月时Ⅰ级融合3例(8.82%),Ⅱ级融合31例(91.18%);末次随访时全部达到Ⅰ级融合。术后腰部或下肢症状即有明显缓解,VAS评分术前(6.3±1.4)分,术后1个月(4.1±1.2)分、术后3个月(2.7±1.4)分、术后6个月(1.6±1.0)分,末次随访时为(1.2±0.8)分;JOA评分术前(13.8±2.4)分,术后1个月为(17.6±2.6)分,术后3个月为(21.7±3.1)分,术后6个月为(24.9±2.7)分,末次随访时为(25.7±1.8)分。VAS评分、JOA评分的差异均有统计学意义。12例(ASIA分级C级2例,D级10例)术前存在神经功能障碍者,末次随访时2例从C级恢复至D级,10例从D级恢复至E级。改良MacNabObjective To explore the clinical efficacy of posterior short-segment internal fixation for the treatment of brucella spondylitis(BS).Methods The medical records of 34 patients with BS admitted from January 2014 to June 2019 were retrospectively analyzed.There were 22 males and 12 females;the age was 52.3±10.6 years(range 35-72 years).On the basis of standardized use of antibacterial drugs,the lumbar spine posterior short-segment internal fixation was used.Twenty-nine cases underwent simple internal fixation,and posterolateral bone graft fusion,while 5 cases underwent primary debridement,autologous bone grafting and interbody fusion.Monitor erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),and test tube agglutination test(SAT)were used to assess inflammation control.Imaging examinations of patients before operation,1 month after operation,3 months after operation,6 months after operation,1 year after operation to the last follow-up were analyzed to evaluate the condition of intervertebral fusion.The clinical efficacy evaluation was based on the pain visual analog scale(VAS),Japanese Orthopaedic Association(JOA)score,modified MacNab grading,and American Spinal Injury Association(ASIA)grading,as well as surgery-related complications.Results The operation time of 34 patients was 104.64±16.72 min(range 65-145 min),the average hospital stay was 16.49±7.41 days(range 7-38 d),and the average postoperative follow-up time was 20.2 months(range 12-34 months).At the last follow-up,the ESR and CRP fell to the normal range,and the SAT was negative.At 3 months postoperatively,11 cases(32.35%)reached Bridwell fusion criteria of grade II,23 cases(67.65%)of grade III;3 cases(8.82%)of grade I fusion at 6 months after surgery,31 cases reached grade II fusion(91.18%);all reached grade I fusion at the last follow-up.After the operation,the symptoms of the waist or lower extremities were significantly relieved.The VAS score was 6.3±1.4 before the operation,4.1±1.2 at 1 month after the operation,2.7±1.4 at 3 months afte

关 键 词：腰椎 布鲁杆菌病 感染 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]