一期后路腰椎布鲁杆菌性脊柱炎患者62例的手术治疗

Surgical treatment of 62 cases with posterior lumbar spine brucellosis

目的探讨腰椎布鲁杆菌性脊柱炎的一期后路病灶清除、横突间植骨、钉棒系统固定的疗效。方法收集2011年2月至2017年4月河北北方学院附属第一医院收治的采用本术式治疗的62例腰椎布鲁杆菌性脊柱炎患者的临床资料,进行回顾性分析。手术疗效评价采用疼痛视觉模拟评分(VAS)评估下肢痛及腰痛缓解程度;Oswestry功能障碍指数(ODI)评定腰部功能恢复程度;Frankel脊髓损伤分级法判断脊髓功能恢复情况。结果入组患者,未发生大血管损伤和脊髓损伤,伤口术后甲级愈合,随访均在1年以上。术后3个月感染指标,均正常。术后3~12个月行X线检查,显示横突间植骨均获得骨性愈合。术后3个月、6个月、12个月随访显示:VAS分值为(3.05±0.65)分、(1.88±0.55)分和(0.31±0.42)分,较术前(6.67±1.85)分均显著下降,差异具有统计学意义(F=11.21、P=0.012);Frankel脊髓损伤分级较术前均显著好转(Z=2.01、P=0.022);ODI分值为(21.15±5.35)分、(12.26±4.55)分和(5.31±3.12)分,较术前(37.87±4.85)分均显著降低(F=9.31、P=0.031)。结论本术式能够对腰椎椎管和神经根管做到有效减压,且疗效确切。长期抗布鲁杆菌药物治疗结合手术治疗是腰椎布鲁杆菌性脊柱炎的有效治疗方案。

Objective To investigate the effect of surgical treatment of lumbar spondylitis, with posterior approach to remove the lesion, bone graft between transverse process and nail rod system were applied to make internal fixation. Methods From February 2011 to April 2017, total of 62 cases with lumbar brucellar spondylitis were collected in the No. 1 Affiliated Hospital of Hebei North University. After surgical treatment, Visual analogue scale（VAS） was used to assess the degree of lower limb pain and lower back pain, Oswestry disability index（ODI） was used to assess the degree of recovery of waist function; Frankel spinal cord injury classification method was used to determine the recovery of spinal cord function. ResultsNo intraoperative vascular injury or spinal cord injury occurred. The incisions healed well. Postoperative follow-up was longer than one year. The infection symptoms disappeared. After 3 months, the blood sedimentation and other infection indexes returned to normal. The result of X-ray examination showed that bone healing occurred in transverse process during 3-12 month. After 3 months, 6 months and 12 months follow-up, VAS score points was（3.05 ± 0.65）,（1.88 ± 0.55） and（0.31 ± 0.42）, respectively, compared with preoperative points（6.67 ± 1.85）, which were significantly lower, with significant difference（F = 11.21, P = 0.012）. The classification of Frankel spinal cord injury was significantly better than before（Z = 2.01, P = 0.022）. The ODI functional disorder index were（21.15 ± 5.35）,（12.26 ± 4.55） and（5.31 ± 3.12）, significantly lower than that of preoperative（37.87 ± 4.85）, with significant difference（F = 9.31, P = 0.031）. Conclusions For vertebral canal and nerve root canal, a complete decompression could be created by the operation. For lumbar Brucella spondylitis, long period oral therapy combined with posterior approach operation was effective.