Clinical effect of closed-suction irrigation in patients with brucellosis spondylitis after one-stage posterior debridement and bone grafting fusion with internal fixation

English Keywords:Brucellosis spondylitis  Closed-suction irrigation  One-stage posterior debridement  Bone graft fusion  Randomized controlled trial

English Abstract:

  【Abstract】 Objectives: The purpose of this study was to observe the effect of closed-suction irrigation in patients with brucellosis spondylitis(BS) after one-stage posterior debridement and bone graft fusion with internal fixation. Methods: 30 patients with BS after one-stage posterior debridement and bone graft fusion with internal fixation, admitted between August 2022 and December 2023, were randomly divided into control group(15 cases) and observation group(15 cases). In the control group, there were 10 males and 5 females, with an age of 44.1±7.8 years; In the observation group, there were 11 males and 4 females, with an age of 42.1±6.6 years. The control group received conventional treatment after operation, and the observation group received gentamicin closed-suction irrigation treatment on the basis of the control group. From the first day after surgery, gentamicin 80mg+normal saline 3000mL was used to continuously irrigate the wound for 2 weeks. The erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), visual analogue scale(VAS), and Oswestry disability index(ODI) were observed before operaion, and on the 1st day after operation, at 1 week, 2 weeks, 3 months, 6 months, and 1 year after operation. The imaging data of the two groups before operation and at 1 year after operation were compared, including lumbar lordosis(LL) and disc height(DH). At 1 year after operation, the fusion rate was evaluated according to Suk classification. The postoperative complications were recorded. Results: On the first day after operation, the levels of ESR and CRP in both groups were significantly higher than those before operation(P<0.05). At 1 week after operation, the CRP level of patients in the two groups was significantly lower than that before operation(P<0.05). At 2 weeks after operation, the ESR of the patients in the observation group was lower than that before operation(P<0.05), while the ESR in the control group was lower than that before operation at 3 months after operation(P<0.05). With the passage of time, the VAS score and ODI of the two groups were significantly lower than those before operation(P<0.05). The ESR, CRP, VAS and ODI in the observation group were significantly lower than those in the control group at 1 week, 2 weeks and 3 months after operation(P<0.05). At 6 months after operation, the ESR and CRP levels of patients in both groups returned to normal. One year after operation, both LL and DH in the two groups of patients increased compared with those before operation(P<0.05). The overall fusion rate was 100% in the control group and 93.33% in the experimental group(P>0.05). No postoperative complications occurred during the study in either group. Conclusions: Closed-suction irrigation after one-stage posterior debridement and bone-graft fusion with internal fixation for the patients with BS can help to reduce the inflammatory markers, relieve back pain and improve lumbar function.