通道辅助下斜外侧入路病灶清创治疗腰椎间隙感染的临床分析

Clinical application research of channel-assisted oblique lateral focus debridement for lumbar space infection

目的探讨通道辅助下斜外侧入路病灶清除,植骨融合固定术治疗腰椎间隙感染的临床效果。方法回顾性分析2018年7月至2022年3月在中山市中医院就诊,并行通道辅助下斜外侧入路病灶清除、植骨融合固定术治疗的18例腰椎间隙感染患者,分析手术时间、出血量、下地活动时间和并发症发生情况,对比手术前后各时间点的感染指标[C反应蛋白(CRP)、红细胞沉降率(ESR)、降钙素原(PCT)]变化,记录患者围手术期视觉模拟疼痛评分(VAS)、日本骨关节炎评分(JOA)和脊柱功能障碍指数(ODI),通过术后影像学检查评估感染控制情况、腰椎融合情况和内固定稳定性情况。结果所有患者均顺利接受手术,手术时间为(203±39)min(162~264 min),术中出血量为(184±68)ml(132~287 ml),术后下地活动时间为(43±12)h(28~58 h),患者均无严重并发症。术后患者CRP、ESR、PCT等感染指标均显著降低至正常水平。术后1年患者VAS评分从(5.9±2.6)降低至(1.0±0.4),ODI评分从(75.6±11.7)恢复至(6.3±2.8),JOA评分从(14.5±2.6)恢复至(26.2±2.0)。术后1年患者复查影像学结果均提示融合情况和内固定稳定性好。结论通道辅助下斜外侧入路病灶清除、植骨融合固定术可用于腰椎间隙感染治疗,临床效果显著,具有清创彻底、创伤小、安全性高、植骨融合充分等特点,值得在临床应用推广。

Objective To investigate the clinical effect of channel-assisted oblique lateral focus debridement and interbody fusion with bone on the treatment of lumbar space infection.Methods A total of 18 patients with lumbar space infection,treated in the Traditional Chinese Medicine Hospital of Zhongshan City from July 2018 to March 2022 using channel-assisted oblique lateral focus debridement and interbody fusion with bone,were retrospectively analyzed.The operation time,amount of bleeding,lying in bedtime and complication of these patients were analyzed.The infection indexes,including C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and procalcitonin(PCT)were evaluated.Besides,the visual analogue scale(VAS)score,the Japanese orthopedic association(JOA)score and the Oswestry disability index(ODI)score were recorded.The infection control,lumbar spinal fusion and internal fixation stability were evaluated using imageological examination.Results All patients received surgery successfully.The operation time was(203±39)min(162~264 min),and the beleeding volume was(184±68)ml(132~287 ml).The lying in bedtime was(43±12)h(28~58 h).No severe complication was observed in all the patients.The infection indexes,including CRP,ESR and PCT,were reduced to normal level after surgery.The VAS score reduced from(5.9±2.6)to(1.0±0.4)one year after surgery,and the ODI score was reduced from(75.6±11.7)to(6.3±2.8).Besides,the JOA score increased from(14.5±2.6)to(26.2±2.0).The internal fixation and bone graft fusion were confirmed by imageological examination one year after surgery.Conclusion Channel-assisted oblique lateral focus debridement and interbody fusion with bone can be used in the treatment of lumbar space infection with remarkable clinical effects.The surgery has the characteristic of radical debridement,minimal trauma,good safety and sufficient bone graft fusion.The surgical technic should be widely used and promoted in clinic.