一期后路手术治疗腰椎布鲁杆菌性脊柱炎合并腰椎滑脱的疗效

Efficacy of single-stage posterior surgery of lumbar brucellosis spondylitis combined with lumbar spondylolisthesis

目的探讨腰椎布鲁杆菌性脊柱炎合并腰椎滑脱外科治疗方法并评价其临床疗效。方法回顾性分析2015年7月至2019年3月首都医科大学附属北京地坛医院收治的16例腰椎布鲁杆菌性脊柱炎合并腰椎滑脱患者的临床资料,其中男性14例,女性2例,年龄46~68岁,平均(59.2±6.5)岁,均采用一期后路病灶清除、复位、减压、内固定、椎间植骨融合术。术后随访12~36个月,平均为(25.0±8.1)个月。记录手术后滑脱复位率、复位丢失率、植骨融合率及并发症发生率。同时,比较手术前后视觉疼痛评分(VAS)、日本骨科学会腰痛评分(JOA)、自主生活能力Oswestry功能障碍指数(ODI)及红细胞沉降率(ESR)、C-反应蛋白(CRP)、虎红平板凝集试验(RBP)以评估临床疗效。结果16例患者VAS评分由术前[8.0(8.0,8.8)]分降至术后2周[2.0(1.3,2.0)]分及术后1年[0.0(0.0,1.0)]分。JOA评分由术前平均(11.8±3.6)分升至术后2周平均(18.6±2.3)分及术后1年平均(23.6±2.7)分。ODI指数由术前平均(88.5±5.6)%降至术后2周平均(35.7±3.1)%及术后1年平均(9.3±5.7)%。ESR由术前[35.5(14.5,43.0)]mm/h降至术后2周平均(12.9±5.3)mm/h及术后1年平均(9.2±3.6)mm/h。CRP由术前平均(20.3±10.2)mg/L降至术后2周平均(7.6±3.1)mg/L及术后1年平均(3.5±1.7)mg/L。术后2周及术后1年,VAS、JOA、ODI、ESR、CRP与术前差异均有统计学差异(P均<0.001);术后1年,VAS、JOA、ODI、ESR、CRP与术后2周差异均有统计学意义(P均<0.001)。术后2周滑脱复位率平均为(91.2±6.7)%,术后1年复位丢失率为[8.0(5.0,9.8)]%。末次随访时,所有患者均获得骨性融合,无内固定松动、断裂等情况发生,且无复发。结论一期后路病灶清除、复位、减压、内固定、椎间植骨融合手术治疗腰椎布鲁杆菌性脊柱炎合并腰椎滑脱可行,通过重建脊柱稳定性来缓解患者疼痛、治愈病灶以及提高生活质量。

Objective To investigate the single-stage posterior surgery surgical treatment of lumbar brucellosis spondylitis combined with lumbar spondylolisthesis,and evaluate its clinical efficacy.Methods The clinical data of 16 patients with lumbar brucellosis spondylitis combined with lumbar spondylolisthesis collected in Beijing Ditan Hospital,Capital Medical University from July 2015 to March 2019 were analyzed,retrospectively,including 14 males and 2 females,aged from 46 to 68 years old,with an average of(59.2±6.5)years old,who were treated through one-stage posterior lumbar lesion removal,reduction,decompression,internal fixation,and bone graft fusion.The postoperative follow-up were 12 to 36 months,with an average of(25.0±8.1)months.The reduction rate of spondylolisthesis,reduction loss rate,bone graft fusion rate and complication rate after surgery were recorded.At the same time,the visual analogue scale(VAS),the Japanese orthopaedic association scores(JOA),the oswestry disability index(ODI),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and rose bengal plate agglutination test(RBP)before and after the operation were compared to evaluate the clinical efficacy.Results VAS score decreased from 8.0(8.0,8.8)preoperatively to 2.0(1.3,2.0)and 0.0(0.0,1.0)at 2 weeks and 1 year after operation,respectively.JOA score increased from the average(11.8±3.6)preoperatively to(18.6±2.3)and(23.6±2.7)at 2 weeks and 1 year after operation,respectively.ODI index decreased from(88.5±5.6)%preoperatively to(35.7±3.1)%and(9.3±5.7)%at 2 weeks and 1 year after operation,respectively.ESR decreased from 35.5(14.5,43.0)mm/h preoperatively to(12.9±5.3)mm/h and(9.2±3.6)mm/h at 2 weeks and 1 year after operation,respectively.CRP decreased from(20.3±10.2)mg/L preoperatively to(7.6±3.1)and(3.5±1.7)mg/L at 2 weeks and 1 year the operation,respectively.Two weeks after surgery and one year after surgery,VAS,JOA,ODI,ESR and CRP were significantly different from those before surgery(all P<0.001).Moreover,VAS,JOA,ODI,ESR and CRP were statistically different at 1 year after operation compared with 2 weeks after operation(all P<0.001).The average reduction rate of spondylolisthesis 2 weeks after surgery was(91.2±6.7)%and the median loss rate of reduction at 1 year after surgery was 8.0(5.0,9.8)%.During the last follow-up,all patients obtained bony fusion,no internal fixation loosening,displacement,breakage,etc and no recurrence occured.Conclusions One-stage posterior lumbar lesion removal,reduction,decompression,internal fixation,and bone graft fusion are feasible for the treatment of lumbar brucellosis spondylitis combined with lumbar spondylolisthesis.The reconstruction of spinal stability could relieve pain,heal lesions and improve the ability to live independently.