Q热合并脊柱感染患者的外科管理

Surgical management of patients with Q fever combined with spinal infection

目的:探讨抗感染药物联合经皮椎间孔镜脊柱病灶清除置管引流术治疗Q热合并脊柱感染患者的有效性和优缺点。方法:回顾性分析2015年4月至2023年7月青岛市中心医院收治的11例Q热合并脊柱感染患者的临床资料,7例患者单纯应用抗感染药物治疗(单纯药物治疗组),4例患者采用抗感染药物联合经皮椎间孔镜脊柱病灶清除置管引流术进行治疗(联合治疗组)。比较两组患者体温恢复、疼痛症状改善情况,并随访观察其感染复发及功能恢复情况。结果:所有患者随访6~24个月,平均(11.9±4.7)个月。联合治疗组患者体温恢复正常、疼痛缓解均较单纯药物治疗组患者早,且差异均有统计学意义(P均<0.05)。出院3个月及末次随访时两组患者疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)差异均无统计学意义(P均>0.05)。两组患者感染复发率差异无统计学意义(P>0.05)。结论:Q热合并脊柱感染采用抗感染药物联合经皮椎间孔镜脊柱病灶清除置管引流术治疗,能够尽早地控制感染、缓解症状,减轻脊柱结构和功能的损害。

Objective:To explore the effectiveness and evaluate the advantages and disadvantages of antimicrobial drugs combined with percutaneous transforaminal endoscopic spinal debridement with catheter drainage for the treatment of patients with Q fever combined with spinal infection.Methods:A retrospective analysis was conducted on the clinical data of 11 patients with Q fever combined with spinal infection at Qingdao Central Hospital from April 2015 to July 2023.Seven patients were treated with antimicrobial drugs alone(drug treatment group),and four patients were treated with a combination of antimicrobial drugs and percutaneous transforaminal endoscopic spinal debridement with catheter drainage(combined treatment group).The recovery of body temperature and improvement in pain symptoms were compared between the two groups,along with follow-up observations on the recurrence of the infection and functional recovery.Results:All patients were followed up for 6-24 months,with an average of(11.9±4.7)months.The combined treatment group exhibited significant earlier normalization of body temperature and pain relief compared to the drug treatment group(all P<0.05).There was no statistically significant difference in visual analog scale(VAS)scores for pain or the Oswestry Disability Index(ODI)between the two groups at three months post-surgery or at the final follow-up(all P>0.05).The recurrence rates of infection were also similar between the two groups(P>0.05).Conclusions:The treatment of with combination of antimicrobial drugs and percutaneous transforaminal endoscopic spinal debridement with catheter drainage can achieve early infection control and symptom relief in patients with Q fever complicated with spinal infection,reducing damage to spinal structure and function.