经皮脊柱内镜清创灌洗在骶髂关节结核中的临床应用

Clinical application of percutaneous spinal endoscopy debridement and lavage in sacroiliac joint tuberculosis

目的:探讨经皮脊柱内镜清创灌洗治疗骶髂关节结核的可行性及临床疗效。方法:对2007年1月至2009年4月采用皮脊柱内镜清创灌洗治疗的7例骶髂关节结核患者进行回顾性分析。其中男2例,女5例;年龄29~69岁;病变部位右侧4例,左侧3例;病程8~144个月;按Kim分型,Ⅲ型5例,Ⅳ型2例。患者术前均应用HRZE四联抗结核药物治疗2~6周。比较手术前后的视觉模拟评分(visual analogue scale,VAS),红细胞沉降率(erythrocyte sedimentation rate,ESR),C-反应蛋白(C-reactive protein,CRP),Oswestry功能障碍指数(Oswestry Disability Index,ODI)。结果:7例患者手术顺利,术中平均出血量<50 ml,无血肿、感染等并发症发生。7例患者的随访时间为18~40个月。疼痛缓解明显,术后1、3、6、12、18个月VAS、ESR、CRP、ODI与治疗前比较,均有改善,末次随访时临床、影像学及实验室检查显示感染消除,并恢复正常生活和工作。结论:经皮脊柱内镜清创灌洗其组织创伤小、靶向操作、疗效肯定、术后恢复快,为骶髂关节结核的微创治疗探索出了新的选择。

Objective:To investigate the feasibility and clinical efficacy of percutaneous spinal endoscopic debridement and lavage for the treatment of sacroiliac joint tuberculosis.Methods:The clinical data of 7 patients with sacroiliac joint tuberculosis treated with percutaneous spinal endoscopic debridement and lavage from January 2007 to April 2009 were retrospectively analyzed.There were 2 males and 5 females,aged from 29 to 69 years old,4 cases on the right side of the lesion and 3 cases on the left side.The course ranged from 8 to 144 months.According to Kim classification,5 cases were typeⅢand 2 cases were typeⅣ.All patients were treated with HRZE quadruple anti-tuberculosis drugs for 2 to 6 weeks before operation.VAS,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),and Oswestry Disability Index(ODI)were compared before and after surgery.Results:All the operations were successful,the intraoperative blood loss was less than 50 ml on average,and no complications such as hematoma and infection were occurred.The follow-up time of 7 cases ranged from 18 to 40 months.Pain relief was obvious,and there was a statistical result in the VAS,ESR,and ODI of the patients at 1,3,6,12,18 months after operation compared with before treatment.At the final follow-up,the patient's clinical,imaging and laboratory examinations showed that the infection had disappeared,and the patient returned to normal life and work.Conclusion:Percutaneous spine endoscopic debridement and lavage has less tissue trauma,targeted operation,definite curative effects,and quick postoperative recovery,which has explored new options for minimally invasive treatment of sacroiliac joint tuberculosis.