一期病灶清除联合后路椎弓根内固定治疗胸腰椎布鲁杆菌病性脊椎炎

CLINICAL EVALUATION OF ONE-STAGE RADICAL DEBRIDEMENT COMBINED WITH POSTERIOR PEDICLE INTERNAL FIXATION FOR BRUCELLAR SPONDYLITIS OF THE THORACIC AND LUMBAR VERTEBRAE

目的探讨布鲁杆菌病性脊椎炎有效的外科治疗方法及临床效果。方法 2002年1月-2010年10月,对78例具有手术指征的胸腰椎布鲁杆菌病性脊椎炎患者采用一期病灶清除联合后路椎弓根内固定治疗。男42例,女36例;年龄24～65岁,平均45岁。病程8～29个月,平均12个月。2个椎体受累70例,3个椎体受累8例。均合并不同程度神经功能损伤。术后随访行疼痛视觉模拟评分(VAS)、神经功能Frankel分级、临床疗效评价以及X线片、MRI影像学观察。结果术后78例均获随访,随访时间12～30个月,平均26个月。无窦道形成及复发。术前及术后1、3、6、12个月VAS评分分别为(9.2±0.6)、(2.4±0.3)、(1.0±0.2)、(0.5±0.4)及0分,术后各时间点均较术前显著改善(P<0.05)。术后各时间点神经功能Frankel分级均较术前显著改善,差异均有统计学意义(P<0.05),其中C、D级改善最为显著。临床疗效评价:术后12个月内均无加重患者;随时间推移,改善及无变化患者逐渐转向痊愈,术后12个月改善率和痊愈率分别为100%和91.03%。影像学评价:术前及术后1、3、6、12个月影像学盲测评价指标评分分别为(0.17±0.03)、(4.11±0.09)、(4.68±0.04)、(4.92±0.08)及5分,术后各时间点均较术前显著改善(P<0.05)。结论一期病灶清除联合后路椎弓根内固定治疗胸腰椎布鲁杆菌病性脊椎炎,在解除疼痛、稳定脊柱、恢复神经功能及早期康复方面均有明显优势。

Objective To discuss the surgical treatment method and effectiveness of brucellar spondylitis.Methods Between January 2002 and October 2010,78 patients underwent one-stage radical debridement and posterior pedicle internal fixation,who were definitely diagnosed as having brucellar spondylitis of the thoracic and lumbar vertebrae.There were 42 males and 36 females,aged 24 to 65 years（mean,45 years）.The disease duration was 8-29 months（mean,12 months）.Two vertebrae were involved in 70 cases and three vertebrae were involved in 8 cases.All of the cases complicated by nerve function damage in different extent before operation.The patients were followed up regularly after operation.The pain score（visual analogue score,VAS）,nerve function Frankel classification,effectiveness evaluation,and the blind test evaluation of X-ray and MRI were performed.Results All 78 cases were followed up 12 to 30 months（mean,26 months）.No sinus tract and recurrence occurred.The VAS scores were significantly improved at 1 month（2.4 ± 0.3）,3 months（1.0 ± 0.2）,6 months（0.5 ± 0.4）,and 12 months（0） when compared with preoperative score（9.2 ± 0.6）（P 0.05）.The nerve function Frankel classification after operation was significantly improved when compared with preoperative one（P 0.05）;the patients in grade C and grade D had the most obvious improvement.The effectiveness evaluation indicated no aggravated cases.As time went on,the improved and unchanged patients were cured gradually and the improvement rate and the curative rate were 100% and 91.03%,respectively at 12 months after operation.The imaging scores were significantly improved at 1 month（4.11 ± 0.09）,3 months（4.68 ± 0.04）,6 months（4.92 ± 0.08）,and 12 months（5） when compared with the preoperative score（0.17 ± 0.03）（P 0.05）.Conclusion One-stage radical debridement combined with posterior pedicle internal fixation is an ideal therapeutic method for brucellar spondylitis of the thoracic and lumbar vertebrae,which has obvious superiority in pain relief,the spine stability,the nerve function recovery,and early rehabilitation.