一期后路病灶清除植骨融合内固定术治疗腰椎布鲁杆菌性脊柱炎

One-stage posterior debridement,bone grafting,fusion and internal fixation for lumbar brucellar spondylitis

目的观察一期后路病灶清除植骨融合内固定术治疗腰椎布鲁杆菌性脊柱炎的临床疗效。方法2011年1月-2017年10月,采用一期后路病灶清除植骨融合内固定术治疗28例晚期腰椎布鲁杆菌性脊柱炎患者,手术前后规范应用多西环素、利福平、三代头孢和甲磺酸左氧氟沙星联合抗感染治疗。术前、术后3个月及末次随访时采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评价临床疗效。随访期间通过X线、CT及MRI检查观察内固定位置、病变节段植骨融合及病情复发情况,记录并发症和再手术情况。结果所有手术均顺利完成。术后切口均一期愈合,无局部窦道形成,无脊髓、马尾神经、神经根或血管损伤发生。术后随访24~37个月,随着时间的推移,患者腰背部疼痛症状均明显缓解,自主生活能力逐步提高,术后3个月及末次随访时VAS评分、ODI均比术前降低,差异有统计学意义(P<0.05)。随访期间无复发、再手术患者,无内固定松动、移位等情况发生。末次随访时2例患者病变节段未融合,但无腰背部疼痛或内固定失效,其余患者术后11~15个月植骨融合,融合率为92.9%(26/28)。结论在抗感染药物治疗的基础上,一期后路病灶清除植骨融合内固定术治疗晚期腰椎布鲁杆菌性脊柱炎疗效满意,能尽快缓解患者疼痛,提高患者生活质量。

Objective To observe the efficacy of one-stage posterior debridement,bone grafting,fusion and internal fixation for lumbar brucellar spondylitis.Methods From January 2011 to October 2017,28 patients with late lumbar brucellar spondylitis were treated with one-stage posterior debridement,bone grafting,fusion and internal fixation.Doxycycline,rifampicin,third generation cephalosporins and levofloxacin mesylate combined standard therapy were used for anti-infective treatment before and after operation.The visual analogue scale(VAS)score and Oswestry disability index(ODI)were used at pre-operation,postoperative 3 months and the final follow-up,so as to evaluate the clinical efficacy.During the follow-up period,roentgenograph,CT and MRI were used to observe the position of internal fixation,the fusion of lesion segments and the recurrence of the disease,and the complications and reoperation were recorded.Results All the operations were successfully completed.The incision healed after operation without local sinus formation,and there were not spinal cord,cauda equina,nerve root and vascular injuries.The patients were followed up for 24-37 months.With the passage of time,back pain was significantly relieved,and the ability of independent living was gradually improved in all the patients.The VAS score and ODI were lower at postoperative 3 months and the final follow-up than those at pre-operation,with statistical significance(P<0.05).No patient experienced recurrence and reoperation,and no internal fixation failure occured,such as loosening or displacement.The lesion segment was not fused in 2 cases with a fusion rate of 92.9%,but no back pain and internal fixation failure occured.The fusion time in the remaining patients was 11-15 months.Conclusion On the basis of antibacterials,one-stage posterior debridement,bone grafting,fusion and internal fixation is a satisfactory method for lumbar brucellar spondylitis,which can relieve back pain as soon as possible and improve the quality of life.