后路单纯病椎间固定融合术治疗腰椎布鲁杆菌性脊柱炎的可行性研究

A feasibility study of posterior fixation and fusion for brucellar spondylitis

目的探讨后路单纯病椎间固定融合术与后路病椎间固定、病灶清除植骨融合术治疗单、双节段腰椎布鲁杆菌性脊柱炎的疗效。方法回顾性分析2014年6月至2018年2月接受手术治疗的63例单、双节段腰椎布鲁杆菌性脊柱炎患者的病历资料,男42例,女21例;年龄(50.9±8.18)岁(范围38~69岁);单节段44例,双节段19例。采用单纯病椎间固定融合术治疗31例(单纯固定组),采用后路病椎间固定、病灶清除植骨融合术治疗32例(病清固定组)。主要观察指标包括手术时间、术中出血量、术后住院时间、术后服药时间、疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)、Frankel分级和临床疗效。结果63例患者随访时间(27.16±6.07)个月(范围15~38个月)。单纯固定组单节段的手术时间为(105.86±16.66)min,术中出血量为(295.00±55.11)ml,术后住院时间为(4.45±1.53)d,均明显少于病清固定组(P<0.001),术后服药时间的差异无统计学意义(P>0.05);单纯固定组双节段的手术时间为(150.33±26.29)min,术中出血量为(242.05±50.56)ml,术后住院时间为(4.56±1.50)d,均明显少于病清固定组(P<0.001),术后服药时间的差异无统计学意义(P>0.05)。末次随访单纯固定组和病清固定组单、双节段的VAS评分及ODI均较术前降低,但两组间的差异无统计学意义(P>0.05)。单节段单纯固定组和病清固定组CRP在术前、术后3个月、末次随访的差异无统计学意义(P>0.05)。双节段单纯固定组和病清固定组术后3个月CRP分别为(1.29±0.52)mg/L和(1.36±0.48)mg/L,较术前(7.39±4.03)mg/L和(6.88±2.91)mg/L明显下降,且差异有统计学意义(P<0.001);术后3个月与末次随访的差异均无统计学意义(P>0.05)。单、双节段单纯固定组和病清固定组ESR术前、术后3个月、末次随访时组内的差异均有统计学意义,组间的差异均无统计学意义(P>0.05)。两组患者术后临床疗效优良率的差异无统计学意义。单纯固定组术后出现并发症2例(6.5%,2/31),病清固定组8例(25%,8/32),发生率的差异有统计学差异(χ^(2)=4.057,P=0.044)。结论在规范抗布鲁杆菌药物治疗的基础上,后路单纯病椎间固定融合术治疗布鲁杆菌性脊柱炎的手术疗效满意,且具有手术创伤小、时间短,术后下地时间早及并发症少的优点。

Objective To investigate the difference between simple posterior interbody fixation and fusion and posterior interbody fixation combined with focus debridement and bone graft fusion for the treatment of mono-and bi-segmental lumbar brucella spondylitis.Methods A total of 63 patients(42 males and 21 females),aged 50.9±8.18 years(range from 38 to 69 years)with mono-and bi-segmental lumbar brucella spondylitis who received surgical treatment from June 2014 to Feb 2018 were retrospectively analyzed.There were 44 cases of mono-segmental and 19 cases of bi-segmental.Thirty-one cases were treated with single posterior interbody fixation and fusion(PIFF group),and 32 caseswere treated with posterior interbody fixation combined with focus debridement and bone graft fusion(debridement group).The main observation indicators include operation time,intraoperative blood loss,postoperative hospital stay,postoperative medication time,Visual Analogue Scale(VAS),Oswestry Disability Index(ODI),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),Frankel score and clinical efficacy.Results All of 63 patients were followed up for 27.16±6.07 months(range 15 to 38 months).The operation time of mono-segmental patients of PIFF group was 105.86±16.66 min,the intraoperative blood loss was 295.00±55.11 ml,and the postoperative hospitalization was 4.45±1.53 days,which was significantly shorter than debridement group(P<0.001),while the postoperative medication time was without significant difference between the two groups(P>0.05).The opration time of bi-segmental patients of PIFF group was 150.33±26.29 min,the intraoperative blood loss was 242.05±50.56 ml,and the postoperative hospitalization was 4.56±1.50 days,which was significantly shorter than debridement group(P<0.001),while the postoperative medication time was also without significant difference between the two groups.At the last follow-up time,the VAS scores and ODI values of mono-and bi-segments in PIFF group and debridement group were lower than those preoperation,but there was no significant difference between the two groups(P>0.05).There was no significant difference in CRP between mono-segments of PIFF group and debridement group at the preoperation,3 months after operation and the last follow-up time(P>0.05).The CRP in mono-segments of PIFF group and debridement group decreased at 3 months after the operation compared with that preoperation,and the difference was statistically significant(P<0.001).There was no significant difference in CRP between bi-segments of PIFF group and debridement group at 3 months after operation and the last follow-up time(P>0.05).There was no significant difference in ESR between mono-and bi-segments of PIFF group and debridement group at 3 months after operation and the last follow-up time(P>0.05).There was significant difference in ESR between mono-and bi-segments of PIFF group and debridement group at the preoperation,3 months after operation and the last follow-up time.There was no statistical difference in the proportion of excellent postoperative clinical efficacy between the two groups.Complications were observed in two patients in PIFF group(6.5%,2/31)compared with 8 patients in debridement group(25%,8/32,χ^(2)=4.057,P=0.044).Conclusion On the basis of standardized anti-brucella drug therapy,simple posterior interbody fixation and fusion for the treatment of brucella spondylitis has a satisfactory surgical effect,and has the advantages of less surgical trauma,shorter time,earlier postoperative movement time and fewer complications.