镜下融合技术治疗腰椎间隙非特异性感染的临床研究

Clinical study of endoscopic fusion technique for treatment of lumbar intervertebral non-specific infection

目的探讨镜下融合技术治疗单节段腰椎间隙非特异性感染的可行性、安全性、有效性及临床疗效。方法选取采用镜下融合技术治疗的20例单节段腰椎间隙非特异性感染患者为研究对象,记录患者的手术情况(手术时间、术中出血量、术中及术后并发症情况)、术后恢复指标[VAS评分、Oswestry功能障碍指数(ODI)评分]、感染指标(白细胞计数、中性粒细胞百分比、红细胞沉降率、C反应蛋白、降钙素原)、手术前后腰椎前凸角、手术前后椎间隙高度、临床疗效及随访情况等。结果本组20例患者的手术时间为(164.00±17.51)min,术中出血量为(76.75±14.35)mL;术中、术后均未出现明显的并发症。术后6个月腰椎前凸角为(26.00±8.14)°,明显高于术前的(21.85±6.60)°,差异有统计学意义(P<0.05);术后6个月椎间隙高度为(9.65±3.25)mm,明显高于术前的(7.92±2.52)mm,差异有统计学意义(P<0.05)。术后2个月,按改良MacNab疗效评定标准,优10例、良9例、可1例、差0例,优良率为95.00%。术后1周,患者的VAS评分、ODI评分、降钙素原水平较术前降低,中性粒细胞百分比、C反应蛋白水平较术前升高,差异均有统计学意义(均P<0.05);而白细胞计数、血沉与术前差异均无统计学意义(均P>0.05)。术后2周,患者的VAS评分、ODI评分、白细胞计数、中性粒细胞百分比、降钙素原水平较术前及术后1周降低,差异均有统计学意义(均P<0.05);而血沉、C反应蛋白水平与术前相比,差异均无统计学意义(均P>0.05);术后2周,C反应蛋白水平低于术后1周,差异有统计学意义(P<0.05)。术后1个月,患者的VAS评分、ODI评分、白细胞计数、中性粒细胞百分比、C反应蛋白、血沉、降钙素原水平较术前、术后1周、术后2周降低,差异均有统计学意义(均P<0.05)。术后2个月,患者的ODI评分、白细胞计数、中性粒细胞百分比、C反应蛋白水平、血沉、降钙素原水平较术前、术后1周、术后2周、术后1个月降低,差异均有统计学意义(均P<0.05);而VAS评分低于术前、术后1周、术后2周,差异均有统计学意义(均P<0.05)。随访6个月,无术后复发病例。术后6个月复查腰椎X线片,均骨性融合,随访期间无内固定螺钉、连接棒松动、断裂,无融合器移位。结论镜下融合技术治疗单节段腰椎间隙非特异性感染安全可行,具有良好的临床疗效。

Objective To investigate the feasibility,safety,efficiency and clinical efficacy of endoscopic fusion technique in the treatment of single-segment lumbar intervertebral non-specific infection.Methods Twenty patients with single-segment lumbar intervertebral non-specific infection treated by endoscopic fusion technique were selected as the research objects.The patients'operation conditions(operation time,intraoperative blood loss,intraoperative and postoperative complications),postoperative recovery indicators(VAS score,Oswestry disability index[ODI]score),infection indicators(white blood cell count,neutrophil percentage,erythrocyte sedimentation rate,C-reactive protein,procalcitonin),preoperative and postoperative lumbar lordotic angle,preoperative and postoperative lumbar intervertebral space height,clinical efficacy and follow-up data were recorded.Results The operation time of the 20 patients was(164.00±17.51)min and the intraoperative blood loss was(76.75±14.35)mL.There were no obvious complications during and after operation.The lumbar lordotic angle was(26.00±8.14)°at 6 months after operation,which was significantly higher than that before operation(21.85±6.60)°,with statistically significant difference(P<0.05).The height of the intervertebral space at 6 months after operation was(9.65±3.25)mm,which was significantly higher than that before operation(7.92±2.52)mm,with statistically significant difference(P<0.05).Two months after operation,according to the modified MacNab efficacy evaluation standard,there were 10 cases of excellent,9 cases of good,1 case of fair,0 cases of poor,with an excellent and good rate of 95.00%.One week after operation,the VAS score,ODI score and procalcitonin level were lower than those before operation,while the neutrophil percentage and C-reactive protein level were higher than those before operation,with statistically significant differences(all P<0.05).There were no statistically significant differences in the white blood cell count and erythrocyte sedimentation rate before and after operation(all P>0.05).Two weeks after operation,the VAS score,ODI score,white blood cell count,neutrophil percentage and procalcitonin level were decreased compared with those before operation and 1 week after operation,with statistically significant differences(all P<0.05),but there were no statistically significant differences in the erythrocyte sedimentation rate and C-reactive protein level before and after operation(all P>0.05).The C-reactive protein level at 2 weeks after operation was lower than that at 1 week after operation,with statistically significant difference(P<0.05).At 1 month after operation,the VAS score,ODI score,white blood cell count,neutrophil percentage,C-reactive protein level,erythrocyte sedimentation rate,and procalcitonin level of patients were decreased compared with those before operation,1 week and 2 weeks after operation,with statistically significant differences(all P<0.05).At 2 months after operation,the ODI score,white blood cell count,neutrophil percentage,C-reactive protein level,erythrocyte sedimentation rate,and procalcitonin level of patients were decreased compared with those before operation,1 week,2 weeks and 1 month after operation,with statistically significant differences(all P<0.05).At 2 months after operation,the VAS score was lower as compared with those before operation,1 week and 2 weeks after operation,with statistically significant differences(all P<0.05).All patients were followed up for 6 months,and there was no postoperative recurrence case.Lumbar radiographs were reexamined 6 months after operation,showing osseous fusion,and there were no internal fixation screws and connection rods loosening and fracture,as well as fusion cage displacement during the follow-up period.Conclusion Endoscopic fusion technique is safe and feasible in the treatment of single-segment lumbar intervertebral non-specific infection,with good clinical efficacy.