椎间孔镜治疗单节段非特异性腰椎间隙感染的效果分析

The Analysis of the Therapeutic Effect of Intervertebral Foramen Endoscopy on Single Segment Non-specific Lumbar Intervertebral Space Infection

目的通过观察后外侧入路椎间孔镜技术与后路腰椎病灶清除植骨融合内固定术治疗单节段非特异性腰椎间隙感染的临床结果,评估后外侧入路椎间孔镜治疗单节段非特异性腰椎间隙感染的疗效和优势。方法对昆明医科大学第一附属医院骨科2016年6月至2023年6月收治的42例非特异性腰椎间隙感染患者的临床资料进行回顾性分析。男24例,女18例,平均54岁,分为A、B 2组,每组21例,A组患者均行后外侧经皮椎间孔镜下清创术,联合软组织浸泡法提高病原学检出率。B组患者均行后路腰椎病灶清除植骨融合内固定术,对比分析手术前后腰痛视觉模拟量表评分(VAS)、日本骨科协会腰椎评分(JOA)、腰椎ODI量表评估患者临床症状缓解情况,白细胞、超敏C反应蛋白、血沉等感染指标,病原耐药菌的治疗效果、细菌培养率和术后并发症。结果采用后外侧经皮椎间孔镜下清创术联合软组织浸泡法,获取病原菌培养阳性率为90%。A/B组的VAS、JOA、ODI,术后1周、末次随访与术前相比均有改善。术后7 d的JOA评分A组分数高于B组,且差异有统计学意义(P<0.05);术后7 d的ODI评分A组低于B组,且差异有统计学意义(P<0.05)。感染指标中,CRP、ESR在术后3 d、术后7 d、A组远小于B组,且逐渐下降,差异有统计学意义(P<0.05)。结论后外侧入路椎间孔镜技术治疗腰椎间隙感染结合软组织浸泡法细菌培养率高、可有效减轻患者疼痛,提高生活质量;明显降低感染指标;对于高龄基础疾病多、细菌毒力强、高热、炎症指标较高、预估置入内固定物感染风险较高、不能耐受全麻手术的的高危患者人群安全有效。

Objective To evaluate the efficiency of posterolateral approach in the treatment of singlesegment nonspecific lumbar spondylodiscitis by observation of the clinical results of posterior lateral percutaneous transforaminal endoscopic debridement(PTED)approach and posterior single segmental lumbar debridement,bone graft and internal fixation in the treatment of single segment nonspecific lumbar spondylodiscitis.Methods In this study,42 patients(males 24 and females 18 with an average age of 54 years)with nonspecific lumbar spondylodiscitis treated in the Department of Orthopaedics of the 1st Affiliated Hospital of Kunming Medical University from June 2016 to June 2023 were analyzed retrospectively.They were divided into group A(n=21)and group B(n=21).All the patients in group A were treated with posterolateral percutaneous transforaminal endoscopic debridement combined with soft tissue immersion to improve the detection rate of etiology.All the patients in group B were treated with posterior single-segment lumbar focus debridement,bone graft and internal fixation.The visual analogue scale score of low back pain(VAS),Japanese Orthopaedic Association Lumbar vertebra score(JOA)and lumbar vertebra ODI scale were compared before and after the operation to evaluate the remission of clinical symptoms,infection indexes such as white blood cells,hypersensitive C-reactive protein,ESR,the therapeutic effect of pathogenic drug-resistant bacteria,bacterial culture rate and postoperative complications.Results The positive rate of pathogen culture obtained through posterior lateral percutaneous foramen debridement combined with soft tissue soaking method was 90%.The score of ODI in group A was lower than that in group B on the 7th day after operation.Among the infection indexes,CRP and ESR in group A were much lower than those in group B at 3 and 7 days after the operation,and the difference was statistically significant(P<0.05).Conclusion Percutaneous transforaminal endoscopic debridement(PTED)in the treatment of lumbar spondylodiscitis combined with soft tissue immersion has a high bacterial culture rate,which can effectively reduce the pain of patients,improve the quality of life,and significantly reduce the index of infection.it is safe and effective for high-risk patients with multiple underlying diseases,strong bacterial virulence,high fever,high inflammation index,high risk of infection with internal fixation and inability to tolerate general anesthesia surgery.