单侧双通道内镜下病灶清除加置管冲洗治疗腰椎感染

Treatment of lumbar infection by endoscopic focus debridement and catheter irrigation via unilateral biportal approach

目的探讨单侧双通道内镜下病灶清除加置管冲洗治疗腰椎感染的临床疗效。方法回顾性分析2020年8月至2021年10月该院收治的6例腰椎感染患者资料,其中腰椎非特异性感染4例,腰椎结核杆菌感染1例,腰椎布鲁氏杆菌感染1例。所有患者均行单侧双通道内镜下病灶清除加置管冲洗引流术,术后根据细菌培养结果,给予敏感药物治疗。监测血沉(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)及腰椎核磁共振(magnetic resonance imaging,MRI)评估疾病控制情况。采用视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry dysfunction index,ODI)及改良MacNab标准评估患者临床疗效。结果6例患者均获随访,平均8.5个月。术后患者腰腿痛症状均完全缓解,术中、术后均未出现严重并发症。与术前相比,术后3 d、1个月、3个月及末次随访时的ESR、CRP均显著降低,差异有统计学意义(P<0.05);术后3 d、1个月、3个月及末次随访时的VAS评分、ODI指数均明显降低,差异有统计学意义(P<0.05);定期复查腰椎MRI提示病灶逐渐变小,甚至消失;末次随访时,参考改良的MacNab疗效标准评定为优5例、良1例,优良率100%。结论单侧双通道内镜下病灶清除加置管冲洗治疗腰椎感染,创伤小、效果好,是一种安全、可靠、有效的治疗方法。

Objective To explore the clinical effect of endoscopic focal debridement and catheter irrigation through unilateral biportal approach in the treatment of lumbar infection.Methods From August 2020 to October 2021,6 cases of lumbar infection admitted to our hospital were retrospectively analyzed.Among them,there were 4 cases of non-specific infection,1 case of tuberculosis infection and 1 case of brucellosis infection of lumbar spine.All patients underwent endoscopic focal debridement and catheter irrigation and drainage through unilateral biportal approach,and were given sensitive drugs according to the results of bacterial culture after surgery.Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and lumbar magnetic resonance imaging(MRI)were monitored to assess the disease control situation.Visual analogue scale(VAS),Oswestry dysfunction index(ODI)and modified MacNab standards were adopted to evaluate the clinical efficacy.Results 6 cases were all followed up for an average of 8.5 months.The pain of lumbago and leg was completely relieved after surgery,no serious complications occurred during and after surgery.Compared with pre-operation,ESR and CRP were significantly decreased at 3 days,1 month,3 months and last follow-up,the difference was statistically significant(P<0.05),VAS scores and ODI index decreased significantly at 3 days,1 month,3 months and last follow-up,with statistical significance(P<0.05).Regular MRI examination showed that the focus was gradually reduced,and even disappeared.At the last follow-up,according to the modified MacNab criteria,5 cases were excellent,1 case was good,and the excellent and good rate was 100%.Conclusions Endoscopic focus debridement and catheter irrigation and drainage through unilateral biportal approach is a safe,reliable and effective method for the treatment of lumbar infection with little trauma and good effect.