单侧与双侧经皮椎间孔镜下清创灌洗术治疗感染性脊柱炎的疗效比较  

Comparison of efficacy of unilateral and bilateral unilateral percutaneous endoscopic debridement lavage in treatment of infectious spondylitis

作　　者：张立栋 张成亮 ZHANG Li-dong;ZHANG Cheng-liang(Department of Orthopedics,Shu yang Hospital Affiliated to Xuzhou Medical University,Xuzhou,jiangsu 223600,China)

机构地区：[1]徐州医科大学附属沭阳医院骨科,江苏宿迁223600

出　　处：《中国骨与关节损伤杂志》2022年第7期678-681,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的比较单侧与双侧经皮椎间孔镜下清创灌洗术治疗感染性脊柱炎的临床疗效。方法回顾性分析自2016-05—2019-05采用经皮椎间孔镜下清创灌洗术治疗的46例感染性脊柱炎,24例采用双侧经皮椎间孔镜下清创灌洗术治疗(双侧组),22例采用单侧经皮椎间孔镜下清创灌洗术治疗(单侧组)。比较两组手术时间、术中透视次数、引流时间,比较两组术前、术后1周、3个月与6个月红细胞沉降率(Erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)水平以及术前、术后1、3、12个月疼痛VAS评分、ODI指数。结果两组均顺利完成手术并获得完整随访,随访时间12~18个月,平均14.5个月。单侧组手术时间、术中透视次数较双侧组少,差异有统计学意义(P<0.05)。两组引流时间比较差异无统计学意义(P>0.05)。病理检查结果显示双侧组慢性炎症反应8例,干酪样坏死6例;单侧组慢性炎症反应7例,干酪样坏死6例。两组术前、术后1周、3个月与6个月ESR、CRP水平比较差异无统计学意义(P>0.05)。两组术前、术后1、3、12个月疼痛VAS评分、ODI指数比较差异无统计学意义(P>0.05)。结论单侧与双侧经皮椎间孔镜下清创灌洗术治疗感染性脊柱炎均能取得满意的效果,但单侧经皮椎间孔镜下清创灌洗术具有手术时间短、透视次数少的优点,且不增加并发症发生率。Objective To compare the clinical effects of unilateral percutaneous endoscopic debridement lavage(PEDL)andbilateral PEDL in the treatment of infectious spondylitis.Methods Forty-six cases of infectious spondylitis treated by PEDLfrom May 2016 to May 2019 were retrospectively analyzed,24 cases with bilateral PEDL(bilateral group)and 22 cases with unilateral PEDL(unilateral group).The operation time,intraoperative fluoroscopy times,and drainage time were compared betweenthe two groups.The levels of erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)before surgery,1 week,3 months,and 6 months after surgery were compared between the two groups.The pain VAS score and ODI index were comparedbetween the two groups before surgery,1,3,and 12 months after surgery.Results Both groups were successfully completedthe operation and obtained complete follow-up.The follow-up time was 12-18 months,with an average of 14.5 months.The operation time and the number of intraoperative fluoroscopy in the unilateral group were less than those in the bilateral group,andthe difference was statistically significant(P<0.05).There was no significant difference in drainage time between the two groups(P>0.05).Pathological examination showed that there were 8 cases of chronic inflammation and 6 cases of caseous necrosis in bilateral group;7 cases of chronic inflammation and 6 cases of caseous necrosis in unilateral group.There was no significant differ-ence in ESR and CRP levels between the two groups before surgery,1 week,3 months,and 6 months after surgery(P>0.05).There was no significant difference in the pain VAS score and ODI index between the two groups before operation,1,3,and 12 months after operation(P>0.05).Conclusion Both unilateral and bilateral PEDL can achieve satisfactory results in the treatment of infectious spondylitis.However,compared with bilateral PEDL,unilateral PEDL has a shorter operation time,fewer fluoroscopic times,and no increased serious complications.

关 键 词：感染性脊柱炎 经皮椎间孔镜下清创灌洗术 经皮腰椎间盘切除术 

分 类 号：R687.3[医药卫生—骨科学]