单侧与双侧后路开窗、病灶清除、植骨融合术治疗腰骶椎布鲁杆菌性脊柱炎

Unilateral or bilateral posterior fenestration debridement and bone graft fusion for the treatment of lumbosacral brucellosis spondylitis

目的分析单侧与双侧开窗、病灶清除、植骨融合内固定术治疗腰骶椎布鲁杆菌性脊柱炎的临床疗效。方法回顾性分析2013年6月至2019年6月行一期后路开窗、病灶清除、植骨融合术治疗的腰骶椎布鲁杆菌性脊柱炎患者48例纳入研究。按照手术方式分为两组,单侧开窗组:行一期后路单侧开窗、病灶清除、植骨融合内固定手术27例,男21例,女6例,年龄23~71岁。双侧开窗组:采用一期后路双侧开窗、病灶清除、植骨融合内固定术21例,男16例,女5例,年龄26~58岁。观察指标包括手术时间、术中出血量、腰部疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(the Oswestry Index,ODI)及日本骨科协会评分(Japanese Orthopaedic Association Scores,JOA)评分、C-反应蛋白、红细胞沉降率等,通过影像学检查评估内固定装置有无松动、断裂,使用Bridwell分级标准评价植骨融合情况,以及术后相关并发症情况。结果所有患者均顺利完成手术,术中病变组织送病检,结果均诊断为布鲁杆菌病。两组术前一般情况无统计学差异(P>0.05)。术后所有患者均获得随访,随访时间(23.7±6.3)个月(范围12~48个月)。两组患者术后各随访时间点C-反应蛋白、红细胞沉降率、VAS评分、ODI及JOA评分均较术前明显改善(P<0.05)。单侧开窗组手术时间、术中出血量分别为(120.5±34.1)min、(214.4±150.2)ml,双侧开窗组为(187.1±30.3)min、(455.8±250.5)ml,差异均有统计学意义(t_(手术时间)=8.123,t_(术中出血量)=2.962,P<0.05)。组间相同时间点C-反应蛋白、红细胞沉降率、VAS评分、ODI及JOA评分的差异均无统计学意义(P>0.05)。双侧开窗组中1例患者术后半个月出现切口感染,行清创引流术后痊愈。两组植骨融合时间的差异无统计学意义(t=0.542,P>0.05),末次随访时均完全融合。结论单侧与双侧开窗、病灶清除、植骨融合内固定术治疗腰骶椎布鲁杆菌性脊柱炎均可取得良好的临床效果,且前者具有手术时间短、出血少、创伤小及医疗费用少等优点。

Objective To analyze the application and clinical efficacy of one-stage unilateral or bilateral fenestration,debridement,interbody fusion combined with posterior internal fixation for the treatment of lumbosacral brucellosis spondylitis.Methods All patients with lumbosacral brucellosis spondylitis were retrospectively analyzed,who underwent fenestration,debridement,interbody fusion combined with posterior internal fixation from June 2013 to June 2019.A total of 48 patients were enrolled in this study.According to the surgical method,they were divided into two groups.Unilateral fenestration group:27 cases of one-stage posterior unilateral fenestration,debridement,interbody fusion combined with posterior internal fixation were performed,21 males and 6 females,aged 23-71 years;Bilateral fenestration group:21 cases of one-stage posterior bilateral fenestration,debridement,interbody fusion combined with posterior internal fixation were performed,aged 26-58 years.There were 16 males and 5 females.The preoperative and postoperative clinical symptoms,neurological function,C-reactive protein,the surgery duration time,the blood loss,and erythrocyte sedimentation rate were observed.The internal fixation device was evaluated for looseness or fracture by imaging examination.The Bridwell classification criteria were used to evaluate the bone graft fusion.Postoperative complications were also assessed.Results All patients completed the operation successfully,and the diseased tissues were sent for pathological examination during the operation,and all of them were diagnosed as brucellosis.All patients were followed up for 12-48 months(mean 23.7±6.3 months).C-reactive protein,erythrocyte sedimentation rate,Visual Analogue Scale(VAS),Oswestry Disability Index(ODI)and Japanese Orthopaedic Association Scores(JOA)were significantly improved in both groups at different time points after operation.There was no significant difference in the general condition before operation between the two groups(P>0.05).The mean operation time and mean blood loss were 120.5±34.1 min and 214.4±150.2 ml,in the unilateral fenestration group;187.1±30.3 min and 455.8±250.5 ml in the bilateral fenestration group;and the difference was significant(t=8.123,t=2.962,P<0.05).The postoperative lumbar and leg pain were significantly relieved.There was no significant difference in C-reactive protein,erythrocyte sedimentation rate,VAS,ODI and JOA scores between the two groups at the same time point.In the bilateral fenestration group,one patient developed incision infection half a month after the operation,who underwent debridement and drainage,and finally cured.There was no significant difference in the time of bone graft fusion between the two groups(t=0.542,P>0.05).At the last follow-up,all the patients were completely fused.Conclusion Unilateral or bilateral fenestration,debridement and bone graft fusion and internal fixation for the treatment of lumbosacral brucellosis spondylitis can achieve good clinical results,and the former has the advantages of short operation time and low cost.