经椎间孔病灶清除椎间融合术治疗腰椎布鲁杆菌脊柱炎的疗效分析

Transforaminal debridement and interbody fusion in lumbar Brucella spondylitis

中文关键词:  布鲁杆菌脊柱炎  腰椎  经椎间孔病灶清除椎间融合术

英文关键词:Brucella spondylitis  Lumbar  Transforaminal lumbar intervertebral body debridement and fusion

中文摘要:

  【摘要】 目的：探讨经椎间孔病灶清除椎间融合术（TLIDF）治疗腰椎布鲁杆菌脊柱炎的可行性及临床疗效。方法： 2010年2月~2015年6月我院采用TLIDF治疗28例腰椎布鲁杆菌脊柱炎患者，术前口服抗布鲁杆菌药物3周，27例采用TLIDF，1例采用TLIDF+前路腰大肌脓肿清除术。术后继续规律口服抗布鲁杆菌药物6周，定期随访。从临床及影像学评价手术疗效，临床评价包括：术前、术后1周内、末次随访时血沉（ESR）、C反应蛋白（CRP），术前、末次随访时腰痛、下肢疼痛视觉模拟评分（visual analogue scales，VAS）及Oswestry功能障碍指数（Oswestry disability index，ODI）；影像学评价包括：定期行腰椎X线片、CT及MRI检查，通过腰椎正侧位X线片和CT评估椎间植骨融合情况，MRI评估感染椎体、椎管及椎旁脓肿清除及炎症愈合情况。采用SPSS 19．0统计软件对数据进行统计分析。结果：术后伤口均一期愈合，无局部窦道形成，无脊髓、马尾或神经根损伤发生。术前ESR为39.3±24.9mm/h，CRP为36.2±27.6mg/L；术后1周ESR为49.8±21.6mm/h，CRP为53.1±22.1mg/L，较术前显著性增高（P<0.05）。末次随访时ESR为9.4±5.8mm/h，CRP为6.1±3.4mg/L，与术前和术后1周相比ESR与CRP显著性降低（P<0.05）。末次随访时腰痛、下肢痛VAS评分和ODI与术前比较均显著性改善（6.28±1.36 vs 2.53±1.26、6.74±2.83 vs 2.05±1.35、37.59±5.85 vs 7.59±2.17，P<0.05）。随访期间无复发病例。结论：TLIDF可有效清除布鲁杆菌脊柱炎病灶、重建脊柱的稳定性；在配合抗布鲁杆菌药物治疗的基础上可取得较好临床疗效。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical feasibility and outcomes of transforaminal debridement and interbody fusion(TLIDF) to treat lumbar Brucella spondylitis. Methods: Twenty-eight patients with lumbar Brucella spondylitis who received TLIDF from February 2010 to June 2015 in our hospital were recruited in the study, conservative treatment was invalid in these patients. Among them, twenty-seven patients received TLIDF, one patient received TLIDF plus abscess removal in anterior papillary muscle. All the patients accepted anti-Brucella drugs for 6 weeks after operation and regular follow-up. Surgical results were evaluated clinically and radiographically, clinical outcomes included: erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) before operation, one week after operation and at the last follow-up; lumbar/lower limb pain visual analogue scale(VAS) and Oswestry disability index(ODI) before operation and at the last follow-up. The radiographical outcomes included bone fusion assessed in lumbar X-ray and CT, lumbar infection, abscess and inflammatory assessed in MRI. SPSS 19.0 statistical software was used in the study. Results: All wounds healed primarily without sinus and neurovascular injury. Before operation, the average ESR was 39.3±24.9mm/h, and the average CRP was 36.2±27.6mg/L. At one week after surgery, the average ESR was 49.8±21.6mm/h and the average CRP was 53.1±22.1mg/L, both of which were significantly higher than those before operation(P<0.05). However, at the last follow-up, the average ESR and CRP were 9.4±5.8mm/h and 6.1±3.4mg/L, which obviously deceased when compared with those before operation and at one week after operation(P<0.05). Lumbar and lower limb VAS were much lower postoperatively when compared with those preoperatively(6.28±1.36 vs 2.53±1.26, 6.74±2.83 vs 2.05±1.35). The preoperative and postoperative ODI scores were 37.59±5.85 and 7.59±2.17, which had significant difference(P<0.05). Meanwhile, no relapse was observed during follow-up in all patients. Conclusions: TLIDF can effectively remove the lesions of brucella spondylitis and reconstruct the stability of spinal column. With the drug therapy, it can achieve satisfactory clinical outcomes.