探讨一期后路计算机导航辅助下置入椎弓根螺钉、病灶清除、椎间植骨融合内固定手术治疗胸椎布鲁氏菌性脊柱炎的临床疗效。

回顾性分析2015年9月至2019年10月首都医科大学附属北京地坛医院收治的19例胸椎布鲁氏菌性脊柱炎患者的临床资料，其中男性12例、女性7例，年龄28～66岁，平均年龄（46.8 ± 11.0）岁。入组患者均有胸背部疼痛，13例（68.4%）患者伴有脊髓或神经压迫症状；入组患者均行一期后路计算机导航辅助下置入椎弓根螺钉、病灶清除、椎间植骨融合内固定手术。选择疼痛视觉模拟评分（VAS）、美国脊髓损伤协会（ASIA）分级、红细胞沉降率（ESR）和C-反应蛋白（CRP）等指标评估手术疗效。

19例患者椎弓根螺钉位置Ⅰ级112枚，置钉准确率93.3%（112/120）。入组患者随访12～36个月，平均（20.9 ± 6.6）个月。19例患者术后胸背部疼痛均明显减轻，功能明显改善。术后2周、术后3个月及末次随访，入组患者VAS评分与术前差异均有统计学意义（P均< 0.001），而末次随访与术后3个月差异无统计学意义（Z =－1.414、P = 0.157）。术后2周，ESR、CRP与术前差异均有统计学意义（P均< 0.001），术后3个月ESR和CRP基本降至正常，且术后3个月及末次随访，ESR、CRP与术前及术后2周差异均有统计学意义（P < 0.001），而末次随访与术后3个月差异均无统计学意义（t = 2.464、P = 0.053，t = 1.711、P = 0.102）。13例伴脊髓或神经压迫症状患者的ASIA分级由术前B级1例，C级2例，D级10例，恢复至末次随访时D级2例，E级11例，差异有统计学意义（χ² = 11.621、P = 0.009）。19例患者均获得骨性融合，无内固定松动、移位等情况发生，均未复发。

计算机导航辅助下手术治疗胸椎布鲁氏菌性脊柱炎具有置入椎弓根置钉准确性高的特点，一期胸椎后路可有效清除病灶组织，改善脊髓神经功能，治愈布鲁氏菌性脊柱炎。

To explore the clinical efficacy of one-stage posterior computer navigation-assisted pedicle screw placement, lesion removal, intervertebral bone graft fusion and internal fixation in the treatment of thoracic brucellosis spondylitis.

From September 2015 to October 2019, 19 patients with thoracic brucellosis spondylitis were retrospectively analyzed. There were 12 males and 7 females, aged from 28-66 years (average, 46.8 ± 11.0 years old). All patients had chest and back pain, 13 (68.4%) patients had different degrees of sensory and motor dysfunction, and all the patients underwent one-stage posterior computer navigation-assisted pedicle screw placement, lesion removal, intervertebral bone graft fusion and internal fixation. The Visual Analogue Scales (VAS), American Spinal Injury Association (ASIA), Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) are used for clinical efficacy evaluation.

Postoperatively, 112 pedicle screws were located in Grade I, and the accuracy rate of screw placement was 93.3% (112/120). The follow-up was 12-36 months, with an average (20.9 ± 6.6) months. The chest and back pain of all patients was significantly reduced after surgery, and the sensory motor function was significantly improved. At 2 weeks after operation, 3 months after operation and the last follow-up, the VAS score was statistically different from that before operation (all P < 0.001), but there was no statistical difference between the last follow-up and 3 months after operation (Z =-1.414, P = 0.157). At 2 weeks after operation, ESR and CRP were statistically different from those before operation (all P < 0.001). At 3 months after operation, ESR and CRP basically dropped to normal. At 3 months after operation and the last follow-up, ESR and CRP were statistically different from those before and 2 weeks after operation (all P < 0.001), but there was no statistical difference between the last follow-up and 3 months after operation (t = 2.464, P = 0.053; t = 1.711, P = 0.102). The ASIA classification of 13 patients with spinal cord or nerve compression symptoms before the operation was 1 case of grade B, 2 cases of grade C and 10 cases of grade D. At the last follow-up, there were 2 cases of grade D and 11 cases of grade E, with statistical difference (χ² = 11.621, P = 0.009). In addition, all patients had bone graft fusion at the last follow-up without complications such as recurrence, loosening of internal fixation and displacement.

The treatment of thoracic brucellosis spondylitis with the aid of computer navigation has the characteristics of high accuracy of pedicle screw placement, and can effectively remove the lesion tissue, eliminate chest and back pain, and restore sensory and motor function. The clinical effect is satisfactory.