内窥镜腰椎间盘术后椎间盘炎的原因及外科治疗

Causes of discitis after microendoscopic discectomy and its surgical treatment

目的探讨腰椎间盘镜（MED）术后致腰椎间盘炎的原因、临床表现特点及微创外科治疗。方法2000年4月至2005年12月，1256例微创腰椎间盘摘除术致腰椎间盘炎6例，发病率0、63％。腰4、5椎间盘炎5例，腰5骶1椎间盘炎1例。所有患者均表现为术后疼痛持续加重，或临床症状缓解后再次出现腰骶部痉挛性剧痛和活动障碍。均伴有血沉（ESR）和C-反应蛋白（CRP）显著增高及MRI早期显著改变。6例腰椎间盘炎患者，2例采用非手术治疗，4例采用腹膜外小切口（3—4cm）椎间隙清创，自体髂骨植骨融合。结果平均随访时间19、7月，手术组的平均卧床时间3、2月，非手术组平均卧床时间7．5月，其腰痛缓解程度和椎间隙高度手术组优于非手术组。结论手术治疗是腰椎间盘炎的最好治疗方法。

Objective To investigate the causes, clinical characteristics and minimal invasive surgical treatment of diseitis following mieroendoseopie diseeetomy （MED）. Methods From Apr. 2000 to Dee. 2005, 1256 patients were treated by minimal invasive lumbar diseeetomy, of whom 6 patients （5 male and 1 female） were implicated with postoperative diseitis, the morbidity of diseitis being 0.63%. The average age of the patients was 38.5 years, ranging from 19 - 54 years, The spinal segment involved included L4 - L5 in five eases, and L5 - S1 in one ease. All the patients presented either continuous aggravating pain or severe spasmus pain and dysfunction in lumbosaeral region after a period of remission of clinical symptoms with remarkable increase of ESR and CRP and early typical signs on MRI. Two patients were treated by conservative method and 4 patients were proeeedeel mimi-open （3-4era） retroperitoneal approach to debride the intervertebral space and transplant auto iliae bone for interbody fusion. Results All the patients were followed up for an average of 14.7 months. The mean time of staying in bed and returning to work in the surgical group was remarkably shorter than that of the conservative group, and the extent of pain release and the height of the intervetebral space were superior to the conservative group. Conclusion Active surgical intervention is the best treatment choice for the lumbar diseitis.