不同入路病灶清除联合植骨内固定术治疗布鲁杆菌性脊柱炎的临床效果  

Therapeutic effect of Brucellar spondylitis treated by different debridement approaches and internal fixation with bone grafting

作　　者：李青松 林崇明 LI Qingsong;LIN Chongming(Department of Orthopedics,Aerospace Central Hospital/Peking University Clinical School of Medicine,Beijing 100115,China)

机构地区：[1]航天中心医院/北京大学航天临床医学院骨科,北京100115

出　　处：《中国医学物理学杂志》2024年第12期1563-1567,共5页Chinese Journal of Medical Physics

基　　金：北京市自然科学基金(18H160143)。

摘　　要：目的:研究不同入路病灶清除联合植骨内固定术应用于胸腰椎布鲁杆菌病性脊柱炎的临床效果。方法:回顾性研究68例布鲁杆菌性脊柱炎患者的临床资料,将接受一期后入路病灶清除术+植骨融合+椎弓根钉棒内固定术的34例患者纳入甲组,将接受一期前入路病灶清除术+植骨融合+椎弓根钉棒内固定术的34例患者纳入乙组,随访1年,乙组脱落3例,甲组脱落1例。比较两组患者的生物力学指标、临床相关指标、影像学盲测评分及并发症。结果:甲组患者手术用时、首次下床时间、住院天数、术中出血量均少于乙组(P<0.05)。术前、术后1、6、12个月,两组患者影像学盲测评分、Cobb角、椎体前缘高度比值无统计学意义(P>0.05);术前、术后6、12个月,两组患者腰背痛目测类评分无统计学意义(P>0.05);术后1月,甲组患者腰背痛目测类评分低于乙组(P<0.05);术后6月两组患者ASIA分级无统计学意义(P>0.05),术后12月两组患者ASIA分级有统计学意义(P<0.05)。两组均未发生严重并发症。结论:两种入路方式均能有效改善患者临床症状,维持脊柱稳定性,利于植入融合,且术后炎症反应得到控制;但后入路术式可缩短手术时间,减少对机体创伤,术后1月的疼痛程度降低明显,尤其可以改善椎管内脊髓神经压迫症状,故而可根据患者病情首选该术式。Objective To investigate the therapeutic effect of different debridement approaches combined with internal fixation with bone grafting in Brucellar spondylitis.Methods A retrospective study was conducted on 68 patients with Brucellar spondylitis.The 34 patients receiving one-stage posterior debridement+bone graft fusion+pedicle screw rod internal fixation were included in group A,while the other 34 patients treated with one-stage anterior debridement+bone graft fusion+pedicle screw rod internal fixation were included in group B.After 1 year of follow-up,3 cases in group B and 1 case in group A fell off.The two groups were compared for biomechanical indexes,clinical indexes,blind imaging scores and complications.Results The operation time,the first time of getting out of bed,the length of hospitalization and the intraoperative blood loss were shorter/less in group A than in group B(P<0.05).The differences in blind imaging score,Cobb angle and anterior vertebral body height ratio before operation and 1,6 and 12 months after operation,as well as the visual analogue scale score for low back pain before operation and 6 and 12 months after operation between two groups were trivial(P>0.05).One month after operation,the visual analogue scale score for low back pain in group A was lower than that in group B(P<0.05).Significant difference between two groups was found inASIA grades at 12 months after operation(P<0.05)but not at 6 months after operation(P>0.05).No serious complications occurred in both groups,and patients'condition improved after active intervention.Conclusion Both debridement approaches can effectively improve clinical symptoms,maintain spinal stability,facilitate graft fusion,and control postoperative inflammation.However,the posterior approach can shorten the operation time,reduce the trauma to the body,and significantly alleviate pain at 1 month after operation,especially improving the symptoms of spinal cord nerve compression in the spinal canal,so it can be preferred if patient's condition permits.

关 键 词：布鲁杆菌性脊柱炎 腰椎 病灶清除术 植骨融合 椎弓根钉棒内固定术 生物力学 神经功能 

分 类 号：R318.01[医药卫生—生物医学工程] R681.5[医药卫生—基础医学]