椎间孔镜联合经皮固定治疗布氏杆菌性脊柱炎合并椎管内脓肿的短期疗效  

Short-term efficacy of transforaminal endoscope combined with percutaneous fixation in the treatment of Brucella spondylitis with intraspinal abscess

作　　者：孙绍铜 刘军 刘莛予 任伟剑 SUN Shao-tong;LIU Jun;LIU Ting-yu;REN Wei-jian(Fifth Department of Orthopedics,Liaoning Provincial People's Hospital,Shenyang Liaoning 110000,China)

机构地区：[1]辽宁省人民医院骨五科,辽宁沈阳110000

出　　处：《局解手术学杂志》2025年第1期38-41,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：辽宁省自然科学基金(2022-BS-056)。

摘　　要：目的 探讨椎间孔镜联合经皮固定治疗单节段布氏杆菌性脊柱炎合并椎管内脓肿的短期临床疗效。方法 回顾性分析2021年3月至2022年8月于我院采用椎间孔镜减压联合经皮固定治疗的14例腰椎单节段布氏杆菌性脊柱炎合并椎管内脓肿患者的临床资料。记录患者手术时间,术中失血量,术前、术后3 d及术后3个月的红细胞沉降率(ESR)及C反应蛋白(CRP),术后引流量,术后卧床时间及并发症发生情况。术前、术后3 d及术后3个月采用疼痛视觉模拟量表(VAS)进行腰背部及腿部疼痛程度评估,采用日本骨科学会(JOA)评分进行腰椎功能评估,Oswestry功能障碍指数(ODI)进行功能障碍评估,采用改良Macnab标准评估疗效优良率。结果 14例患者手术时间182~217 min,平均(197.3±18.6)min;术中平均出血量(37.8±15.5)mL;平均引流量(23.5±5.8)mL;术后卧床时间(3.5±1.4)d。与术前比较,术后3 d及术后3个月ESR和CRP逐渐下降,差异有统计学意义(P<0.05)。术后各随访时间点腰背部和腿部VAS评分、JOA评分及ODI均较术前明显改善,差异有统计学意义(P<0.05)。术后3个月随访,患者疗效优良率为85.7%。结论 利用椎间孔镜微创技术治疗布氏杆菌性脊柱炎合并椎管内脓肿可进行椎管内神经根减压、脓肿清除、局部术区冲洗,明显缓解下肢疼痛,联合经皮固定可显著减轻患者腰背痛症状,改善功能,两种术式结合治疗布氏杆菌性脊柱炎具有微创、安全、有效的特点。Objective To investigate the short-term efficacy of transforaminal endoscope combined with percutaneous fixation in the treatment of single-segment Brucella spondylitis with intraspinal abscess.Methods The clinical data of 14 patients with single-segment lumbar Brucella spondylitis with intraspinal abscess treated by transforaminal endoscopic decompression combined with percutaneous fixation in our hospital from March 2021 to August 2022 were retrospectively analyzed.The operation time,intraoperative blood loss,erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) before operation,3 days and 3 months after operation,postoperative drainage volume,postoperative bed rest time and occurrence of complications were recorded.Before operation,3 days and 3 months after operation,the visual analogue scale(VAS) was used to evaluate the pain degree of lower back and leg,the lumbar function was evaluated by Japanese Orthopaedic Association(JOA) score,Oswestry disability index(ODI)was used to evaluate the dysfunction,and the modified Macnab criteria was used to evaluate the good to excellent rate of efficacy.Results The operation time of 14 patients was 182~217 min,with an average of(197.3±18.6) minutes.The mean intraoperative blood loss was(37.8±15.5)mL;the mean drainage volume was(23.5±5.8)mL;the postoperative bed rest time was(3.5±1.4) days.ESR and CRP gradually decreased 3 days and 3 months after operation compared with those before operation,with statistically significant differences(P<0.05).The VAS scores of lower back and legs,JOA scores,and ODI at each time point of follow-up after operation were significantly improved compared with those before operation,with statistically significant differences(P<0.05).After 3 months of follow-up,the good to excellent rate of efficacy was 85.7%.Conclusion The minimally invasive technique of transforaminal endoscope in the treatment of Brucella spondylitis with intraspinal abscess can conduct neuraxial root decompression,abscess removal,and local surgical area irrigatio

关 键 词：布氏杆菌性脊柱炎 经皮内固定 椎间孔镜 椎管内脓肿 

分 类 号：R681.5[医药卫生—骨科学]