一期后路有限病灶清除内固定联合个体化药物治疗体系在布病脊柱炎治疗中的应用  

Establishment and clinical application of one-stage posterior limited lesion clearance and internal fixation combined with personalized drug therapy system for brucellosis spondylitis

作　　者：杨新明[1] 贾永利[1] 张瑛[1] 阴彦林[1] 张培楠[1] 田野 姚尧 陈丽星 Yang Xinming;Jia Yongli;Zhang Ying;Yin Yanlin;Zhang Peinan;Tian Ye;Yao Yao;Chen Lixing(Department of Orthopaedics,the First Affiliated Hospital 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,张家口075000

出　　处：《中华解剖与临床杂志》2022年第2期98-105,共8页Chinese Journal of Anatomy and Clinics

基　　金：河北省政府资助省级临床医学优秀人才项目(361009);河北省卫生健康技术研究暨成果转化重点项目(zh2018014);河北省医学适用技术跟踪项目(G2018074);河北省医学科学研究课题计划(20200504)。

摘　　要：目的探讨一期后路有限病灶清除内固定联合个体化药物治疗布病脊柱炎的可行性及临床疗效。方法回顾性研究。纳入2014年1月—2019年1月河北北方学院附属第一医院骨科布病脊柱炎患者44例,均行一期后路有限病灶清除内固定联合个体化药物治疗。其中,男26例、女18例,年龄32~65岁,发病时间3~7个月。病变位于胸腰段2例、腰椎32例、腰骶段10例。观察指标:(1)手术时间、术中出血量等围手术期指标;(2)比较术前与术后3、6、9、12个月时红细胞沉降率(ESR)、C反应蛋白(CRP)、虎红平板凝集试验(RBPT)等炎性指标和腰疼视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)评分;(3)比较术前与末次随访时患者美国脊柱损伤协会(ASIA)神经功能分级和体质量指数(BMI);(4)影像学评估脊柱稳定性、炎性控制、脊髓神经受压、植骨融合、邻椎退变情况。结果本组44例患者切口均一期愈合,个体化药物治疗期间监测肝肾功能均无损害,术后3~9个月达到临床治愈标准。其中28例为病椎置钉患者,术后18~26个月取出脊柱内固定物并行组织学检查,未见炎性表现。(1)患者手术时间70~120(80±10)min,出血量200~400(250±20)mL。(2)患者ESR、CRP、VAS及ODI评分术前为(55.42±11.42)mm/1 h、(55.40±17.56)mg/L、(6.56±1.33)分、68.84%±4.55%,术后各时间点均较术前改善,差异均有统计学意义(F=87.58、92.54、54.28、165.48,P值均<0.001)。术前RBPT阳性44例,术后3、6、9个月分别为6、1、0例。(3)末次随访,术前16例神经功能损害均得到改善,ASIA分级由C级6例、D级10例,改善为D级1例、E级15例;患者BMI由术前(16.8±0.2)kg/m^(2)改善为(23.5±1.8)kg/m^(2),营养状态良好,差异有统计学意义(t=2.14,P=0.031)。(4)随访X线检查显示,椎弓根钉在病椎固定及正常椎体上固定的把持力好,无松动、断裂、脱钉情况,脊柱稳定,椎间植骨颗粒无吸收、无脱落,植骨融合时间3~9个�Objective This study aimed to investigate the feasibility and clinical efficacy of one-stage limited focus debridement and posterior internal fixation system combined with individualized medication therapy in the treatment of brucella spondylitis(BS).Methods A total of 44 patients(26 males and 18 females;32-65 years old)with BS who underwent one-stage limited focus debridement and posterior internal fixation system combined with individualized medication therapy in the Department of Orthopedics,the First Affiliated Hospital of Hebei North University,from January 2014 to January 2019,were retrospectively reviewed.The disease time varied from 3 months to 7 months.The incidence of segment:2 cases of thoracolumbar,32 cases of lumbar,and 10 cases of lumbosacral.Observation index:(1)Perioperative indexes such as operation time and intraoperative blood loss;(2)The inflammatory indexes such as erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rosebengal plate agglutination test(RBPT),back pain visual analogue scale(VAS)score,and Oswestry disability index(ODI)score were compared before the operation and 3,6,9,and 12 months after the operation.(3)The patient's American Spinal Injury Association(ASIA)neurological function classification and body mass index(BMI)were compared before the operation and at the last follow-up.(4)Spinal stability,inflammatory control,spine and nerve compression,bone graft fusion,and adjacent vertebrae degeneration were assessed via imaging examination.Results The incisions of 44 patients in this group healed at first stage,and there was no impairment of the liver and kidney function during the personalized drug therapy.The patients reached the clinical cure standard at 3-9 months after the operation.Twenty-eight patients received reoperation to remove the internal fixation at 18-26 months after the operation,and the samples were sent to histological examination(no positive inflammatory manifestation was reported).(1)Operation time was 70-120(80±10)min,and blood loss volume was 200-400(2

关 键 词：布鲁杆菌病 脊椎炎 有限病灶清除术 个体化药物治疗 临床疗效 

分 类 号：R681.51[医药卫生—骨科学]