单纯后路手术治疗腰骶椎布氏杆菌性脊柱炎的临床疗效

Clinicalefficacyofposterior surgeryfor lumbosacralspinalbrucellosis

目的探讨后路病灶清除、植骨融合、内固定术治疗腰骶椎布氏杆菌性脊柱炎的临床疗效。方法回顾性分析2012年2月-2015年4月采用后路病灶清除、植骨融合、内固定术治疗腰骶椎布氏杆菌性脊柱炎患者24例,其中男性14例,女性10例,年龄37~59岁,平均(43.1±17.9)岁,术后至少随访12月。根据术前和末次随访时腰疼VAS评分、ODI评分、腰椎功能JOA评分评价后路手术的临床疗效。随访中观察ESR、CRP水平的变化及手术并发症。采用Bridwell融合标准评价植骨融合情况。结果所有患者均顺利完成手术,手术时间110~240 min,平均(153.4±46.2)min,术中出血量180~1200 mL,平均(378.6±187.4)mL。24例均获得随访,平均随访时间(21.1±10.2)月。末次随访时,腰骶部VAS评分和ODI评分改善率分别为90.9%、80.7%。根据腰椎功能JOA评分,手术疗效优17例,良5例,中2例,总的优良率为92%。与术前相比,上述评分均有明显统计学差异(P<0.05)。末次随访时,21例得到骨性融合,融合率达到87.5%,未发现感染复发者。结论对于有明确手术指征的腰骶椎布氏杆菌性脊柱炎患者,采用后路手术创伤小,病灶清除及神经减压彻底,能得到满意、可靠的疗效,是一种简单,安全的手术方法。

Objective To discuss the clinical efficacy of posterior debridement, interbody fusion and instrumentation for lumbosacral spinal brucellosis. Methods 24 patients with lumbosacral spinal brucellosis including 14 males and 10 females, aged 37 to 59 years old with mean value of（43.1±17.9）, who were treated by debridement, interbody fusion and instrumentation through posterior approach from February 2012 to April 2015, were analyzed retrospectively,. All patients were followed up at least 12 months. Clinical efficacy of posterior surgery was evaluated based on the preoperative and last follow-up back pain VAS score, ODI score, as well as the JOA score. ESR, CRP levels and the postoperative surgical complications were observed during the follow up period. The fusion status was evaluated using Bridwell evaluation criteria. Results All patients were successfully operated. The surgery duration time was ranged from 110 to 240 minutes, and average value was（153.4±46.2）minutes. Mean blood loss was（378.6±187.4）mL（ranged 180～1200ml）. All patients were followed up successfully, with an average follow-up time of（21.1±10.2）months. At the last follow-up, back pain VAS score and ODI score were improved to 90.9%, 80.7% respectively. JOA score improvement rate was excellent in 17 cases, good in 5 cases, moderate in 2cases, and a total improvement rate was 92%. There were significant difference between above scores（P〈0.05）. 21 cases achieved solid bony fusion, with a fusion rate of 87.5%. There were no recurrence of disease in any of patients. Conclusion For the patients with lumbosacral spinal brucellosis, who have definitive surgical indications, posterior surgery can accomplish nerve decompression and debridement thoroughly, get satisfied and reliable clinical effect. It is a safe, less invasive and very simple surgical approach.