一期后路病灶清除椎间融合内固定治疗重症腰椎间盘炎

One stage posterior debridement and fusion for severe lumbar discitis

目的:探讨一期病灶清除椎间植骨融合内固定治疗重症腰椎间盘炎的效果。方法:2005年12月～2010年12月对经保守治疗无效的5例原发、11例继发椎间盘炎患者采用经后路椎间病灶清除、椎间钛质cage支撑、同种异体骨植骨融合、椎弓根内固定手术治疗。采用视觉模拟评分法(VAS)评估患者术前及术后第1、7、14天及末次随访时的疼痛程度。通过监测患者手术前后血沉(ESR)及C-反应蛋白(CRP)的变化来评估病情的转归。通过术后X线片来评估脊柱的稳定性和植骨融合情况。结果:患者术后即感腰腿痛明显缓解,床上能自行翻身,术前腰腿痛VAS评分为8.25±2.21分,术后VAS评分第1天为4.36±2.43分,第7天为2.59±2.13分,第14天为2.38±1.13分,末次随访时为1.88±1.21分。所有患者的VAS评分术后明显低于术前,差异有统计学意义(P<0.05),术后第7、14天及末次随访时VAS评分明显低于术后第1天,差异有统计学意义(P<0.05)。术后第7、14天及末次随访时VAS评分间差异无统计学意义(P>0.05)。4例患者术后出现血沉升高,3d后逐渐下降,所有病例CRP术后均明显下降,2～4周时ESR和CRP恢复正常(ESR<15mm/h,CRP<8mg/L)。所有患者术后切口无感染。随诊6～24个月,平均13个月,所有患者腰腿痛消失,病变椎间隙在6～12个月均达骨性融合。结论:后路病灶清除椎间融合内固定治疗重症腰椎间盘炎能迅速缓解腰腿痛,重建脊柱稳定性,是治疗重症椎间盘炎的有效手段之一。

Objectives： To evaluate the efficacy of one stage posterior debridement and fusion for severe lumbar discitis. Methods： From December 2005 to December 2010, 11 cases suffering from severe lumbar discitis and no responsive to conventional treatment experienced one stage posterior debridement, allograft bony graft and fusion. VAS score was used to evaluate clinical outcome of preoperation and 1, 7, 14 days and final follow-up after operation. Erythrocyte sedimentation rate（ESR） and C reactive protein（CRP） were used to assess the pre and postoperative general condition. X-ray was used to evaluate the stability and bone fu- sion. Results： All the patients had low back pain relieved significantly after operation and were capable of turning around. The VAS for low back pain was 8.25±2.21, 4.36±2.43, 2.59±2.13, 2.38±1.13 and 1.88±1.21 for preoperation, 1, 7, 14 day and final follow-up respectively, which showed significant difference between preoperation and postoperation counterparts （P〈0.05）. Four patients had ESR increased 3 days after operation, then decreased gradually. All patients had CRP decreased significantly after surgery, and had ESR and CRP returning to normal（ESR〈15mm/h, CRP〈8mg/L） 2 to 4 weeks later. No skin incision infection was noted. All patients were followed up for 6-24 months（average 13 months）, and all patients got bony fusion 6-12 months later. Conclusions： One stage posterior debridement and fusion is anti-inflammatory and can reach pain-relief quickly as well as stability reconstruction, which is effective for severe discitis.