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中华实验和临床感染病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (04) : 370 -375. doi: 10.3877/cma.j.issn.1674-1358.2018.04.011

所属专题: 经典病例 文献

论著

一期后路腰椎布鲁杆菌性脊柱炎患者62例的手术治疗
田野1, 杨新明1,()   
  1. 1. 075000 张家口市,河北北方学院附属第一医院骨科
  • 收稿日期:2017-12-15 出版日期:2018-08-15
  • 通信作者: 杨新明
  • 基金资助:
    2018年度河北省医学适用技术跟踪项目(No. G2018074); 2018年度河北省卫生健康技术研究暨成果转化重点项目(No. zh2018014); 2017年张家口市市级科技计划(No. 17120010D)

Surgical treatment of 62 cases with posterior lumbar spine brucellosis

Ye Tian1, Xinming Yang1,()   

  1. 1. Bone Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
  • Received:2017-12-15 Published:2018-08-15
  • Corresponding author: Xinming Yang
  • About author:
    Corresponding author: Yang Xinming, Email:
引用本文:

田野, 杨新明. 一期后路腰椎布鲁杆菌性脊柱炎患者62例的手术治疗[J/OL]. 中华实验和临床感染病杂志(电子版), 2018, 12(04): 370-375.

Ye Tian, Xinming Yang. Surgical treatment of 62 cases with posterior lumbar spine brucellosis[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(04): 370-375.

目的

探讨腰椎布鲁杆菌性脊柱炎的一期后路病灶清除、横突间植骨、钉棒系统固定的疗效。

方法

收集2011年2月至2017年4月河北北方学院附属第一医院收治的采用本术式治疗的62例腰椎布鲁杆菌性脊柱炎患者的临床资料,进行回顾性分析。手术疗效评价采用疼痛视觉模拟评分(VAS)评估下肢痛及腰痛缓解程度;Oswestry功能障碍指数(ODI)评定腰部功能恢复程度;Frankel脊髓损伤分级法判断脊髓功能恢复情况。

结果

入组患者,未发生大血管损伤和脊髓损伤,伤口术后甲级愈合,随访均在1年以上。术后3个月感染指标,均正常。术后3~12个月行X线检查,显示横突间植骨均获得骨性愈合。术后3个月、6个月、12个月随访显示:VAS分值为(3.05 ± 0.65)分、(1.88 ± 0.55)分和(0.31 ± 0.42)分,较术前(6.67 ± 1.85)分均显著下降,差异具有统计学意义(F= 11.21、P= 0.012);Frankel脊髓损伤分级较术前均显著好转(Z= 2.01、P= 0.022);ODI分值为(21.15 ± 5.35)分、(12.26 ± 4.55)分和(5.31 ± 3.12)分,较术前(37.87 ± 4.85)分均显著降低(F= 9.31、P= 0.031)。

结论

本术式能够对腰椎椎管和神经根管做到有效减压,且疗效确切。长期抗布鲁杆菌药物治疗结合手术治疗是腰椎布鲁杆菌性脊柱炎的有效治疗方案。

Objective

To investigate the effect of surgical treatment of lumbar spondylitis, with posterior approach to remove the lesion, bone graft between transverse process and nail rod system were applied to make internal fixation.

Methods

From February 2011 to April 2017, total of 62 cases with lumbar brucellar spondylitis were collected in the No. 1 Affiliated Hospital of Hebei North University. After surgical treatment, Visual analogue scale (VAS) was used to assess the degree of lower limb pain and lower back pain, Oswestry disability index (ODI) was used to assess the degree of recovery of waist function; Frankel spinal cord injury classification method was used to determine the recovery of spinal cord function.

Results

No intraoperative vascular injury or spinal cord injury occurred. The incisions healed well. Postoperative follow-up was longer than one year. The infection symptoms disappeared. After 3 months, the blood sedimentation and other infection indexes returned to normal. The result of X-ray examination showed that bone healing occurred in transverse process during 3-12 month. After 3 months, 6 months and 12 months follow-up, VAS score points was (3.05 ± 0.65), (1.88 ± 0.55) and (0.31 ± 0.42), respectively, compared with preoperative points (6.67 ± 1.85), which were significantly lower, with significant difference (F= 11.21,P= 0.012). The classification of Frankel spinal cord injury was significantly better than before (Z= 2.01,P= 0.022). The ODI functional disorder index were (21.15 ± 5.35), (12.26 ± 4.55) and (5.31 ± 3.12), significantly lower than that of preoperative (37.87 ± 4.85), with significant difference (F= 9.31,P= 0.031).

Conclusions

For vertebral canal and nerve root canal, a complete decompression could be created by the operation. For lumbar Brucella spondylitis, long period oral therapy combined with posterior approach operation was effective.

图1 布鲁杆菌性脊柱炎光镜下HE染色(200 ×)
图2 典型患者X线以及MRI
表1 手术前后62例患者Frankel脊髓损伤分级[例(%)]
表2 62例患者手术前后VAS评分和ODI指数(±s,分)
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