一期斜外侧腰椎椎间融合术联合Wiltse入路椎弓根螺钉固定治疗非特异性腰椎间隙感染

One⁃stage debridement via oblique lumbar interbody fusion corridor combined with Wiltse approach pedicle screw fixation for treatment of single⁃level lumbar pyogenic spondylodiscitis

目的探讨一期斜外侧腰椎椎间融合术(oblique lumbar interdody fusion,OLIF)联合Wiltse入路椎弓根螺钉固定治疗非特异性腰椎间隙感染的临床疗效。方法回顾性分析我院2014年1月至2018年12月采用OLIF技术联合Wiltse入路椎弓根螺钉固定治疗非特异性腰椎间隙感染的21例病人的临床资料。记录手术时间、术中出血量、并发症发生情况,通过各时间点的红细胞沉降率、C-反应蛋白、白细胞计数评估感染控制情况,通过比较术前及术后各观察点的疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)评估临床疗效。基于术后影像学检查结果评估有无内固定松动、断裂及植骨融合情况等。结果所有病人手术均顺利完成,手术时间为(226.7±40.8)min,术中出血量为(232.4±58.0)mL。随访(15.3±6.9)个月(12~36个月)。12例病人疼痛症状明显缓解,VAS评分及ODI均持续下降,腰痛VAS评分由术前(7.0±1.2)分下降至末次随访(1.0±0.9)分,ODI指数由术前66.5%±10.0%下降至末次随访12.9%±3.1%,术后各观察时间点的VAS评分及ODI与术前比较,差异均有统计学意义(P均<0.05)。红细胞沉降率、C-反应蛋白、白细胞计数均在术后3个月内恢复正常。影像学结果显示无内固定松动、断裂情况,术后1年融合率为100%。结论OLIF技术联合Wiltse入路椎弓根螺钉固定治疗非特异性腰椎间隙感染临床疗效满意,具有创伤小、病灶清除彻底、植骨充分、安全性好等优点,为非特异性腰椎间隙感染的治疗提供了一种新的选择。

Objective To investigate the clinical efficacy of one⁃stage debridement via oblique lumbar interbody fusion(OLIF)corridor combined with posterior Wiltse approach fixation for treatment of single⁃level lumbar pyogenic spondylodiscitis.Methods The clinical data of 21 patients with lumbar pyogenic spondylodiscitis treated by OLIF combined with Wiltse approach pedicle screw fixation from January 2014 to December 2018 in our hospital were retrospectively analyzed.The operation time,intraoperative blood loss and complications were recorded.The infection control was evaluated by erythrocyte sedimentation rate(ESR),C⁃reactive protein(CRP),and white blood cell(WBC)count.The clinical efficacy was evaluated by visual analogue scale(VAS)score and Oswestry disability index(ODI)before and after operation.Based on the results of postoperative imaging examination,the internal fixation loosening,fracture and bone graft fusion were evaluated.Results All surgeries were successfully completed.The operation time was(226.7±40.8)min,and the blood loss was(232.4±58.0)mL.All patients were followed up for(15.3±6.9)months(12⁃36 months).Totally,12 patients had significant relief of low back pain,the VAS score and ODI decreased continuously,the VAS score of low back pain before operation was 7.0±1.2,and decreased significantly to 1.0±0.9 at the last follow⁃up.The ODI index decreased significantly from 66.5%±10.0%before operation to 12.9%±3.1%at the last follow⁃up.Compared with those before operation,there were significant differences in VAS score and ODI at each observation time point after operation(all P<0.05).The ESR,CRP,and WBC count returned to normal within 3 months after surgery.Imaging showed no loosening or rupture of internal fixation in each follow⁃up time point.The intervertebral fusion rate was 100%at 1st year after operation.Conclusion One⁃stage debridement via OLIF combined with posterior Wiltse approach fixation for treatment of single⁃level lumbar pyogenic spondylodiscitis is satisfactory with the advantages of minimal trauma,radical debridement,sufficient bone graft and good safety.