腰椎布鲁杆菌病手术方式的选择及其疗效分析

Selection of surgical methods for Brucellosis in lumbar spine and its clinical efficacy

目的探讨腰椎布鲁杆菌病手术方式的选择并对其治疗效果进行分析。方法将89例腰椎布鲁杆菌病患者分为A组49例选择经前路病灶清除植骨融合内固定术,B组40例选择后路固定联合前路病灶清除植骨融合术。记录并比较2组手术时间、术中出血量、住院时间和植骨融合时间,比较2组术前、术后1个月、末次随访时的疼痛视觉模拟评分法(Visual Analogue Scale,VAS)评分、Oswestry功能障碍指数(Oswestry Disability Index,ODI)评分、美国脊柱损伤协会(American Spinal Injury Assoeiation,ASIA)评分、红细胞沉降率、Cobb角和Bridwell分级。结果 A组术中出血量少于B组,手术时间及住院时间短于B组,差异均有统计学意义(P<0.05);2组植骨融合时间差异无统计学意义(P>0.05);2组VAS评分和ODI评分均呈逐渐下降趋势、ASIA评分呈逐渐升高趋势,2组在时点间差异有统计学意义(P<0.05),在组间、组间·时点间交互作用差异无统计学意义(P>0.05);2组植骨融合率差异无统计学意义(P>0.05)。结论根据腰椎骨质破坏程度及脓肿范围个体化选择手术方式联合规范的药物治疗腰椎布鲁杆菌病,均可获得满意的治疗效果。

Objective To explore the choice of surgical methods for Brucellosis and analyze the therapeutic effects.Methods Eighty-nine patients with lacteal Brucellosis divided into two groups.In group A,forty-nine patients were treated with anterior debridement,bone graft fusion and internal fixation.In Group B,forty patients were selected for posterior fixation and anterior debridement and bone graft fusion.The operative time,intraoperative blood loss,hospitalization time,bone fusion time before and after surgery were recorded and compared.Visual Aanalogue Scale（VAS）score,Oswestry Disability Index（ODI）score and the American Spinal injury Assoeiation（ASIA）score were compared between the two groups before operation,one month after operation,and at the last follow-up.erythrocyte sedimentation rate and Cobb angle,Bridwell grading.Results The blood loss in group A was less than that in group B.The operation time and length of hospital stay were shorter than those in group B.The difference was statistically significant（P〈0.05）.There was no significant difference in bone fusion time between the two groups（P〉0.05）.The VAS scores and ODI scores of both groups showed a gradually decreasing trend,and the ASIA scores showed a gradually increasing trend.The differences between the two groups at the time points were statistically significant（P〈0.05）.The interactions among groups,groups and time points were observed.The difference was not statistically significant（P〉0.05）.There was no significant difference in bone graft fusion rate between the two groups（P〉0.05）.Conclusion According to the degree of bone destruction of the lumbar spine and the range of abscesses,individualized surgical methods combined with standardized drugs for the treatment of lumbar Brucellosis can achieve satisfactory therapeutic effects.