手术治疗胸腰椎布鲁杆菌性脊柱炎

Treatment of the brucellar spondylitis in the thoracic and lumbar vertebrae by surgery

中文关键词:  布鲁杆菌性脊柱炎  胸腰椎  病灶清除术  内固定  疗效

英文关键词:Brucellar spondylitis  Thoracic and lumbar vertebrae  Focal cleaning  Internal fixation  Effect

中文摘要:

  【摘要】 目的：探讨手术治疗胸腰椎布鲁杆菌性脊柱炎的方法及临床效果。方法：2002年1月～2010年10月采用手术治疗布鲁杆菌性脊柱炎患者134例，患者均经药物治疗后局部症状及体征无明显好转，经MRI检查有难以吸收的椎旁或椎管内硬膜外脓肿、破坏的椎间盘或炎性肉芽组织突入椎管压迫脊髓、马尾或神经根，或者伴有脊柱不稳定。其中56例采用病灶清除植骨融合术（A组），78例采用病灶清除植骨融合联合后路椎弓根螺钉内固定术（B组）；术后继续规范药物治疗，并辅助高压氧治疗。术前及术后3d、2周、3个月、12个月时对两组患者进行VAS评分，术后3、6、12个月进行临床疗效随访，对两组不同时间点的结果进行统计学分析。结果：两组手术均顺利完成，术中无相关并发症。A组随访12～24个月，平均18个月，21例患者术后8～11个月（平均10个月）植骨愈合，脊柱稳定；35例患者术后植骨不愈合，6例脊柱不稳定；4例出现压疮，3例发生下肢深静脉血栓，4例术后12个月症状复发。B组随访12～30个月，平均26个月；术后5～10个月（平均8个月）植骨均愈合，脊柱稳定，无相关并发症发生，其中32例取出脊柱内固定装置，同时取骨组织作病理学检查未见炎性表现。两组术后各时间点VAS评分与术前比较均有统计学差异（P<0.05），早期B组改善更明显；术后3、6、12个月时的优良率A组分别为60.71%、85.71%、92.85%， B组分别为92.30%、98.71%、100%，两组术后各时间点与前一时间点比较差异有统计学意义（P<0.05），术后同一个时间点B组优良率高于A组， 差异有统计学意义（P<0.05）。结论：布鲁杆菌性脊柱炎在药物治疗的基础上，经两种手术方法均可以有效清除病灶，缓解或解除疼痛，病灶清除联合后路椎弓根螺钉内固定术后能维持脊柱稳定性，减少并发症，有利患者早期康复和治愈病灶，提高临床疗效。

英文摘要:

  【Abstract】　Objectives: To discuss the methods and clinical effect of treatment of the brucellar spondylitis in the thoracic and lumbar vertebrae by surgery. Methods:　From January 2002 to October 2010, 134 cases of brucellar spondylitis were treated by surgery. Of which 56 cases in group A were treated by focal cleaning, bone grafting and fusion, and 78 cases in group B were treated by focal cleaning, bone grafting and fusion combined with posterior pedicle internal fixation. All of the patients were treated by drugs and had no improved symptoms and signs. There was hardly absorbable paravertebral abscess or epidural abscess in the vertebral canal, or destructive intervertebral disc, or inflammatory granulation tissue protruding into the vertebral canal and opressing the spinal cord, cauda eguina or nerve root, or unstable spine by MRI in all the cases. The patients were treated by standard drugs after the operation, assisting hyperbaric oxygen treatment again. VAS score was performed before the operaiton and 3 days, 2 weeks, 3 months and 12 months afer the operation. The cases were followed up at the 3rd, 6th and 12th month after the operation. The data between the two groups and in different period were analyzed by statistics. Results:　Operations in the two groups were completed successfully and there was no correlated complication during the operation. Group A was followed up for 12 to 24 months and for 18 months on average. There were 21 cases with bone healing and stable spine, and the healing time was 8 to 11 months, 10 months on average; there were 35 cases with bone disunion, of which 6 cases with unstable spine, 4 cases with pressure ulcer, 3 cases with deep veins of lower limb and 4 cases recurring 12 months after the operation. Group B was followed up for 12 to 30 months and for 26 months on average. All the cases in group B had bone healing and stable spine with no correlated complication, and the healing time was 5 to 10 months, 8 months on average. In 32 cases, the internal nut-locking devices were taken out, and inflammation was not found in the bone tissues by pathologic observation. By comparing the VAS score on each period after the operation with which before the operation, the difference had statistical significance(P<0.05), with more obvious improvement in group B in the early period. The good rate on the 3rd, 6th and 12th month after the operation was 60.71%, 85.71% and 92.85% respectively in group A and 92.30%, 98.71% and 100% respectively in group B. By comparing the good rate on each point-in-time after the operation with which on the former point-in-time in the two groups, the difference had statistical significance(P<0.05). The good rate in group B was much better than that in group A on the same point-in-time after the operation, and the difference had statistical significance(P<0.05). Conclusions: Both two operation methods can clear focus of infection, alleviate or remove the pain, and cure brucellar spondylitis on the base of drug treatment. After focal cleaning, bone grafting and fusion combined with posterior pedicle internal fixation, the spine stabilization and reduction of complications can be realized, which is beneficial for the early rehabilitation of patients and clinical effect improvement.