经皮内镜下病灶清除减压术治疗 腰椎布鲁氏菌脊柱炎的短期临床疗效研究  

Short-term clinical efficacy of percutaneous endoscopic debridement decompression in treatment of lumbar brucellosis spondylitis(LBS)

作　　者：佟敏[1,2] 亚生江·阿卜都热西提+ 金蓉[1,2] 张思平 董振宇 张斌[1,2] 王荣 李世达[1,2] 黄异飞 TONG Min;Yashengjiang Abudurexiti+;JIN Rong;ZHANG Siping;DONG Zhengyu;ZHANG Bin;WANG Rong;LI Shida;HUANG Yifei(The Second Department of Spine,Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University;Xinjiang Uygur Autonomous Region Institute of Traditional Chinese Medicine,Urumqi 830000,China;Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region,Urumqi 830002,China)

机构地区：[1]新疆医科大学附属中医医院脊柱二科 [2]新疆维吾尔自治区中医药研究院,乌鲁木齐830000 [3]新疆维吾尔自治区疾病预防控制中心,乌鲁木齐830002

出　　处：《新疆医科大学学报》2025年第4期406-409,420,共5页Journal of Xinjiang Medical University

基　　金：国家自然科学基金项目(81960812);新疆维吾尔自治区科技创新领军人才-高层次领军人才项目(2022TSYCLJ0027);省部共建中亚高发病成因与防治国家重点实验室开放课题项目(SKL-HIDCA-2019-ZY19)。

摘　　要：目的研究经皮内镜下病灶清除减压术治疗腰椎布鲁氏菌脊柱炎(Lumbar brucella spondylitis,LBS)的临床疗效。方法回顾性分析2013年1月-2022年12月新疆医科大学附属中医医院脊柱二科收治的接受经皮内镜下病灶清除减压术治疗的15例患者的临床资料。记录纳入患者性别、年龄、手术节段等一般资料,以及手术时间、术中出血量与并发症等围手术期指标,分析并比较术前、术后1周、3月、6月、12月腰部和下肢视觉模拟评分(Visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、红细胞沉降率(Erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)之间的差异,比较术前、术后1周椎间隙高度(Intervertebral disc height,IDH)、腰椎前凸角(Lumbar lordosis angle,LLA)、节段性LLA以及腰椎局部病灶变化情况的差异。结果15例患者均顺利完成手术。与术前相比,术后1周、3个月、6个月、12个月患者腰背部VAS评分、下肢VAS评分、ODI指数、ESR和CRP水平均降低,差异有统计学意义(P<0.05)。与术后1周相比,术后3个月、6个月、12个月患者下肢VAS评分、ODI指数、ESR和CRP水平均降低,术后12个月患者腰背部VAS评分降低,差异有统计学意义(P<0.05)。与术后3个月相比,术后12个月患者腰背部VAS评分、下肢VAS评分及ODI指数均降低,差异有统计学意义(P<0.05)。与术前相比,术后1周患者LLA增加,椎间隙炎性灶范围缩小,差异有统计学意义(P<0.05)。结论经皮内镜下病灶清除减压术能够显著缓解腰部及下肢疼痛,恢复腰椎功能及生理曲度,促进炎性吸收,是治疗早期稳定性LBS的有效微创术式。Objective To explore the clinical efficacy and safety of percutaneous endoscopic lesion removal and decompression in the treatment of lumbar brucella spondylitis(LBS).Methods The clinical data of 15 patients admitted to the hospital who underwent percutaneous endoscopic lesion removal and decompression treatment from January 2013 to December 2022 were retrospectively analysed.General data such as gender,age,surgical segment and perioperative indicators such as surgical time,intraoperative bleeding and complications were recorded,and analysed the differences between the preoperative,1-week postoperative,3-month,6-month and 12-month visual analogue scale(VAS),Oswestry disability index(ODI),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and compared the preoperative and 1-week postoperative intervertebral disc height(IDH),lumbar lordosis angle(LLA),segmental LLA and local lesion changes in the lumbar spine.Results All 15 patients successfully completed the surgery.Compared with preoperative levels,patients showed a significant decrease in lower back VAS scores,lower limb VAS scores,ODI index,ESR,and CRP levels at 1 week,3 months,6 months,and 12 months postoperatively(P<0.05).Compared with one week after surgery,the lower limb VAS scores,ODI index,ESR,and CRP levels of patients decreased at 3,6,and 12 months after surgery.The lower back VAS scores of patients decreased at 12 months after surgery,and the differences were statistically significant(P<0.05).Compared with 3 months after surgery,the VAS scores of the waist and back,lower limb VAS scores,and ODI index of patients decreased significantly at 12 months after surgery(P<0.05).Compared with preoperative levels,patients showed an increase in LLA and a reduction in the range of inflammatory lesions in the intervertebral space one week after surgery,with statistically significant differences(P<0.05).Conclusion Percutaneous endoscopic lesion removal and decompression significantly relieves lower back and lower extremity pain restores lumbar spine function

关 键 词：布鲁氏菌脊柱炎 经皮内镜下病灶清除术 脊柱内镜 微创 

分 类 号：R681.5[医药卫生—骨科学]