经皮椎弓根钉内固定联合椎间孔镜下病灶清除治疗腰椎椎间隙感染

Treatment of lumbar intervertebral space infection with percutaneous pedicle screw fixation combined with debridement under transforaminal endoscopy

目的探讨经皮椎弓根钉内固定联合椎间孔镜下病灶清除治疗腰椎椎间隙感染的疗效。方法采用经皮椎弓根钉内固定联合椎间孔镜下病灶清除治疗37例腰椎椎间隙感染患者,术中取病灶组织进行细菌培养和病理检查。手术前后采用疼痛VAS评分评估患者腰腿痛情况,采用JOA评分评估疗效。结果术后病灶标本细菌培养:金黄色葡萄球菌18例,铜绿假单胞菌6例,大肠埃希菌5例,白色葡萄球菌3例,5例培养结果为阴性。患者均获得1年随访。VAS评分:术后2周及1、3个月均低于术前(P <0.01),术后各时间段依次降低,差异均有统计学意义(P <0.01)。JOA评分:术后1个月、1年均高于术前(P <0.01),术后1年高于术后1个月(P <0.01)。术后1年JOA评分治疗改善率:优28例,良6例,可3例,优良率为91.9%。结论经皮椎弓根钉内固定联合椎间孔镜下病灶清除治疗腰椎椎间隙感染具有创伤小、康复快、临床疗效确切的优点。

Objective To investigate the effect of percutaneous pedicle screw fixation combined with transforaminal endoscopic debridement in the treatment of lumbar intervertebral space infection. Methods The 37 patients with lumbar intervertebral space infection were treated by percutaneous pedicle screw fixation combined with transforaminal endoscopic debridement,bacterial culture and pathological examination were performed during the operation. The pain VAS was used to evaluate the lower back and leg pain before and after operation,and the JOA score was used to evaluate the curative effect. Results The bacterial culture result of postoperative focus specimens: 18 cases were Staphylococcus aureus,6 cases were Pseudomonas aeruginosa,5 cases Escherichia coli,3 cases Staphylococcus albus,5 cases were negative. All patients were followed up for 1 year. VAS: at 2 weeks and 1,3 months after operation,which was lower than that at the preoperation( P < 0. 01),the VAS were decreased successively over time,there were statistical differences at postoperative various time periods. JOA score: at 1 month and 1 year after operation,which was higher than that before operation( P < 0. 01),and which of postoperative 1 year was higher than that of postoperative 1 month. Conclusions Percutaneous pedicle screw fixation combined with transforaminal endoscopic debridement has the advantages of less trauma,fast recovery and exact clinical effect in the treatment of lumbar intervertebral space infection.