手术治疗经皮椎体成形术误治化脓性脊柱炎患者的疗效观察

Observation on the curative effect of surgical treatment of suppurative spondylitis after percutaneous vertebroplasty

中文关键词:  化脓性脊柱炎  经皮椎体成形术  手术治疗

英文关键词:Suppurative spondylitis  Percutaneous vertebroplasty  Surgical treatment

中文摘要:

  【摘要】 目的：观察手术治疗经皮椎体成形术（percutaneous vertebroplasty，PVP）误治后的化脓性脊柱炎的临床疗效。方法：回顾性分析2017年3月～2022年2月我院骨科收治的14例PVP误治后的化脓性脊柱炎患者的病历资料，其中男性6例，女性8例，年龄53～83岁（69.3±7.8岁），术后随访12个月，统计手术时间、术中出血量、术后并发症、术后复发率、术后疼痛视觉模拟（visual analogue scale，VAS）评分及美国脊髓损伤协会残损（American Spinal Injury Association，ASIA）分级改善情况、植骨融合率，采用生活质量评定简表（short form-36，SF-36）评估生活质量改善情况，分析手术治疗PVP误治后的化脓性脊柱炎的临床效果及相关风险。结果：14例患者的手术时间为123～300min（205.1±57.4min），术中出血量为200～900mL（517.9±181.5mL）。2例（14.3%）患者出现切口并发症，1例为切口积液，经过引流积液及切口换药处理后愈合；1例为切口延迟愈合，通过定期切口换药，改善机体营养状态，控制血糖后切口愈合。患者术前VAS评分为3～8分（6.1±1.6分）；末次随访时VAS评分为0～2分（0.9±0.8分），差异有统计学意义（t=11.034，P=0.000）。13例患者植骨融合，植骨融合率为92.8%（13/14）；植骨融合时间3～7个月（4.6±1.3个月）；1例植骨未融合的患者术后7个月时脊柱感染复发，表现为内固定松动及椎体后凸畸形，经抗感染、控制合并症及再次手术后治愈。术前ASIA分级D级2例，E级12例，末次随访时均为E级。末次随访时患者的SF-36评分结果较术前有明显改善，术前生理健康综合测量评分为31.4±6.9分，术后为79.8±6.0分，差异有统计学意义（t=19.721，P=0.000）；术前心理健康综合测量评分为46.9±7.2分，术后为88.5±6.4分，差异有统计学意义（t=16.027，P=0.000）。结论：手术能够有效治疗PVP误治后的化脓性脊柱炎，改善患者的生活质量。

英文摘要:

  【Abstract】 Objectives: To observe the clinical effect of surgical treatment of suppurative spondylitis after percutaneous vertebroplasty(PVP). Methods: The medical records of 14 patients with suppurative spondylitis after PVP treatment admitted to the Department of Orthopedics of our hospital from March 2017 to February 2022 were retrospectively analyzed. There were 6 males and 8 females, aged 53-83 years, with an average age of 69.3±7.8 years. The patients were followed up for 12 months. The operation time, intraoperative blood loss, postoperative complications, postoperative recurrence rate, postoperative visual analogue scale(VAS) and American Spinal Injury Association(ASIA) improvement, postoperative bone graft fusion rate, and postoperative quality of life(short form-36, SF-36) improvement were analyzed to observe the clinical effect and related risks of surgical treatment of suppurative spondylitis after PVP treatement. Results: The operative time of 14 patients was 123-300min, with an average of 205.1±57.4min. Intraoperative blood loss was 200-900mL, with an average of 517.9±181.5mL. Postoperative incision complications occurred in 2 patients(14.3%), of which, 1 case was incision effusion, healed after drainage and dressing change; The other case was delayed healing, which healed after regular dressing change, improving nutritional status and blood sugar control. The VAS scores ranged from 3 to 8 points(6.1±1.6 points) before operation, which was 0-2 points(0.9±0.8 points) at final follow-up, and the difference was statistically significant(t=11.034, P=0.000). The bone graft fusion rate was 92.8%(13/14), and the fusion time was 3 to 7 months(4.6±1.3 months). Spinal infection recurred at 7 months after surgery in the 1 patient with unfused bone graft, who presented internal fixation loosening and kyphotic deformity and was cured after anti-infection, control of complications, and reoperation. According to the ASIA classification, 2 patients were grade D and 12 patients were grade E before surgery, which all improved to grade E at final follow-up. At final follow-up, the SF-36 scores of the patients were significantly improved compared with those before surgery, and the comprehensive measurement score of physiological health was 31.4±6.9 before surgery and 79.8±6.0 after surgery, and the difference was with statistical significance(t=19.721, P=0.000). The comprehensive measurement score of mental health was 46.9±7.2 before surgery and 88.5±6.4 after surgery, and the difference was statistically significant(t=16.027, P=0.000). Conclusions: Surgery can effectively treat suppurative spondylitis after PVP treatment and improve the quality of life of patients.