椎间孔镜下清创联合自制引流管冲洗系统治疗双通道脊柱内镜椎管减压术后腰椎感染的疗效分析

Efficacy analysis of transforaminal endoscopic debridement combined with a custom-designed irrigation and drainage system for treating lumbar infections following unilateral biportal endoscopic spinal canal decompression

中文关键词:  腰椎感染  椎间孔镜  双通道脊柱内镜  自制引流管冲洗系统

英文关键词:Lumbar intervertebral infections  Unilateral biportal endoscopic  Percutaneous transforaminal endoscopic  Custom-designed irrigation and drainage system

中文摘要:

  【摘要】 目的：观察椎间孔镜下清创联合自制引流管冲洗系统冲洗治疗双通道脊柱内镜单纯椎管减压术后腰椎硬膜外积液合并感染的临床疗效。方法：回顾性分析2020年10月~2025年4月山西白求恩医院诊治的12例双通道脊柱内镜下单纯椎管减压术后腰椎感染患者[男5例，女7例，年龄74~84岁（79.1±3.4岁）]，采用椎间孔镜下清创、联合自制引流管冲洗系统冲洗治疗，并根据细菌培养结果选择特异性抗生素灌注治疗。治疗后3d、1个月及末次随访时复查患者白细胞计数、中性粒细胞占比（%）、红细胞沉降率（erythrocyte sedimentation rate，ESR）、C-反应蛋白（C-reactive protein，CRP）、细胞因子中白介素6（interleukin-6，IL-6）的数值，并在上述随访时间记录患者的腰痛视觉模拟量表（visual analogue scale，VAS）评分、日本骨科协会（Japanese Orthopaedic Association，JOA）评分以及Oswestry功能障碍指数（Oswestry disability index，ODI），视患者恢复情况复查腰椎MRI观察患者腰椎术后影像学改变。末次随访时，按照改良MacNab标准评价术后疗效。结果：12例患者均获得随访，随访时间6~12个月（9.3±3.1个月）。12例患者感染均得到治愈，未发生感染复发情况，切口一期愈合。末次随访时所有患者白细胞计数、中性粒细胞百分比（%）、ESR、CRP、IL-6的数值均恢复至正常范围。术后1个月时的腰痛VAS评分为3.67±0.58分，JOA评分为24.00±2.00分，ODI为（27.33±4.16）%；末次随访时腰痛VAS评分为2.13±0.68分，JOA评分为25.33±1.53分，ODI为（14.67±2.08）%，与术前相比差异均具有统计学意义（P＜0.05）。末次随访时，12例患者的腰椎MRI显示硬膜外积液及感染较清创前明显改善，按照改良MacNab标准评定疗效：优10例，良2例。结论：椎间孔镜下清创联合自制引流管冲洗系统冲洗是双通道脊柱内镜术后腰椎感染的一种可行、安全且有效的治疗方案。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacy of percutaneous transforaminal endoscopic debridement combined with irrigation using a custom-designed irrigation and drainage system for the treatment of epidural fluid accumulation with lumbar intervertebral infections following unilateral biportal endoscopic(UBE) decompression surgery. Methods: A retrospective analysis was conducted on 12 cases of lumbar infections after UBE lumbar spinal canal decompression treated at Shanxi Bethune Hospital from October 2020 to April 2025. There were 5 males and 7 females, aged 74-84(79.1±3.4) years old. All the patients underwent transforaminal endoscopic debridement combined with irrigation using a custom-designed irrigation and drainage system, with targeted antibiotic perfusion therapy based on bacterial culture results. Follow-up assessments were performed at 3d, 1 month, and the final follow-up, including tests for white blood cell count, neutrophil percentage(%), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), and interleukin-6(IL-6) levels among cytokines. Additionally, visual analog scale(VAS) scores for low back pain, Oswestry disability index(ODI), and other relevant clinical scores were recorded at these intervals. Lumbar MRI was performed based on patient recovery to observe postoperative imaging changes. At final follow-up, the postoperative efficacy was evaluated according to the modified MacNab criteria. Results: All 12 cases were followed up for 6-12 months(9.3±3.1 months). The infections were successfully eradicated in all patients, with no recurrence observed and primary wound healing achieved. At the final follow-up, laboratory markers including white blood cell count, neutrophil percentage(%), ESR, CRP, and IL-6 levels had normalized. Lumbar pain VAS scores was 3.67±0.58 points at 1 month after operation, while JOA scores was 24.00±2.00 points and ODI was (27.33±4.16)%. By the final follow-up, VAS scores improved to 2.13±0.68 points, JOA scores to 25.33±1.53 points and ODI to (14.67±2.08)%. The differences from the preoperative values were statistically significant(P<0.05). At final follow-up, lumbar MRI findings of 12 patients showed significant improvement in the epidural effusion and infection from the conditions before debridement, and the outcomes were rated as excellent in 10 cases and good in 12 cases according to the modified MacNab criteria. Conclusions: Percutaneous transforaminal endoscopic debridement combined with irrigation via a custom-designed irrigation and drainage system technique is a feasible, safe, and effective treatment for lumbar infections following UBE decompression surgery.