通道辅助下微创椎间融合术联合短节段病椎固定治疗非特异性腰椎间隙感染

Channel-assisted minimally invasive interbody fusion and short segmental vertebral fixation for the treatment of non-specific lumbar intervertebral infection

目的:探讨通道辅助下微创经椎间孔腰椎椎间融合(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)技术联合经皮短节段病椎固定治疗非特异性腰椎椎间隙感染的疗效。方法:回顾性分析2014年1月至2018年1月12例非特异性腰椎椎间隙感染患者的资料,其中男8例,女4例,年龄39~65(51.00±12.36)岁。感染部位:L2,32例,L3,43例,L4,56例,L5S11例。其中合并高血压3例,糖尿病2例,泌尿系感染2例。12例患者均无腰部穿刺及手术史。所有患者行Quadrant通道辅助下MIS-TLIF技术病灶清除、自体植骨融合,经皮短节段病椎椎弓根螺钉内固定术,术中取病变组织行细菌培养和病理检查。记录手术时间、术中出血量、术前和术后1周及随访期间的红细胞沉降率(erythrocyte sedimentation rate,ESR)及C-反应蛋白(C-reactive protein,CRP);采用视觉模拟评分(visual analogue scale,VAS)和日本骨科协会(Japanese Orthopaedic Association,JOA)评分来评价临床疗效;采用影像学资料评估腰椎融合情况。结果:所有患者手术顺利,手术时间(176.00±20.76)min,术中出血量(155.00±30.56)ml。术后随访12~18(14.69±4.78)个月。术后1周及末次随访时的VAS及JOA评分较术前明显改善(P<0.01)。末次随访JOA改善率为94%,所有患者红细胞沉降率及C-反应蛋白降至正常,植骨获骨性融合。病变组织细菌培养阳性7例,阴性5例。结论:通道辅助下MIS-TLIF技术病灶清除、自体植骨融合,联合短节段病椎固定,是一种临床疗效可靠、安全、微创的治疗非特异性腰椎间隙感染的手术方法。

Objective:To explore the clinical effect of channel-assisted minimally invasive transforaminal lumbar interbody fusion combined with percutaneous short segmental vertebral fixation for the treatment of non-specific lumbar intervertebral infection.Methods:The clinical data of 12 patients with non-specific lumbar intervertebral infection treated from January 2014 to January 2018 were retrospectively analyzed.There were 8 males and 4 females,aged 39 to 65(51.00±12.36)years old.Infection site located in L2,3 of 2 cases,L3,4 of 3 cases,L4,5 of 6 cases,L5S1 of 1 case.There were 3 cases of hypertension,2 cases of diabetes,and 2 cases of urinary tract infection.None of the 12 patients had a history of lumbar puncture and surgery.Debridement,autogenous bone grafting,minimally invasive transforaminal lumbar interbody fusion via Quadrant invasive system,and percutaneous short segmental vertebral fixation were performed in the patients,the diseased tissue samples were collected for bacterial culture and pathological examination.The operation time and the amount of intraoperative blood loss were recorded.The erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were measured before and after operation.Visual analogue scale(VAS)and Japanese Orthopaedic Association(JOA)scores were used to evaluate the clinical effects and the imaging data were used to assess the fusion of vertebral body.Results:All operations were successful,with operation time of(176.00±20.76)min,and the intraoperative blood loss of(155.00±30.56)ml.The patients were followed up for 12 to 18(14.69±4.78)months.The VAS and JOA scores at 1 week after operation and at the final follow-up were significantly improved(P<0.01).The improvement rate of JOA in the final follow-up was 94%.The erythrocyte sedimentation rate and C-reactive protein were reduced to normal level in all patients,and the bone grafting got fusion.There were 7 cases of positive bacterial culture and 5 cases of negative.Conclusion:Debridement,autogenous bone grafting and minimally invasive transforaminal lumbar interbody fusion via Quadrant invasive system combined with percutaneous short segmental vertebral fixation is a safe,clinically reliable,minimally invasive surgical procedure for the treatment of non-specific lumbar intervertebral space infections.