CT引导经皮脊柱内窥镜病灶清除加置管治疗胸腰椎脊柱感染

Treatment of thoracolumbar spinal infections with percutaneous endoscopic focalectomy and intubation under CT guidance

目的探讨CT引导下经皮脊椎内窥镜技术治疗胸腰椎脊柱感染的方法和疗效。方法经临床和影像学检查诊断明确的腰椎间盘术后椎间隙感染6例,胸腰椎布鲁氏杆菌病7例,腰椎结核4例。在CT引导下定位穿刺病灶,置入扩张套管建立工作通道,单纯放置双腔引流管或内窥镜下清除病灶并置入双腔引流管;术后通过双腔引流管注入药物灌洗引流,配合口服或静脉药物治疗。结果 17例获得10~24个月的随访,椎间隙感染和布鲁氏杆菌病均治愈,腰椎结核治愈3例、好转1例。结论 CT引导经皮脊椎内窥镜病灶清除加置管技术操作简便、安全、微创,是治疗胸腰椎脊柱感染的有效方法。

Objective To explore the technique and efficiency of percutaneous endoscopic focalectomy and intubation guided by CT for thoracolumbar spinal infections. Methods Seventeen patients including 6 cases of spondylodiscitis, 7 cases of brucellosis spinal infections, 4 cases of spinal tuberculosis received the treatment. The focuses of the spinal infections were located and percutaneously punctured under CT guidance. The passage of the puncture was progressively dilated and the work cannulas into the focuses was established, double lumen catheters were put through the work cannulas or endoscopic focalectomy was performed firstly and the catheters were put in. Continuous focal antibiotics perfusion and drainage were given postoperatively with taking medications by mouth or intravenously. Results Seventeen cases were followed up for 10-24 months, 6 cases of spondylodiscitis and 7 cases of brucellosis spinal infections and 3 cases of spinal tuberculosis were cured,1 case of spinal tuberculosis improved. Conclusion Percutaneous endoscopic focalectomy and intubation under CT guidance is an easy, simple, safe, efficient and less invasive method for the treatment of thoracolumbar spinal infections.