Yang Xinming, Zhang Lei, Zhang Ying, Wang Yaoyi, Meng Xianyong, Yin Yanlin, Shi Wei, Zhang Junwei, Zhang Peinan, Zhao Yusen
Department of Orthopaedics, First Affiliated Hospital of Hebei North University, Zhangjiakou Hebei 075000, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Mar;26(3):266-71.
To discuss the surgical treatment method and effectiveness of brucellar spondylitis.
Between January 2002 and October 2010, 78 patients underwent one-stage radical debridement and posterior pedicle internal fixation, who were definitely diagnosed as having brucellar spondylitis of the thoracic and lumbar vertebrae. There were 42 males and 36 females, aged 24 to 65 years (mean, 45 years). The disease duration was 8-29 months (mean, 12 months). Two vertebrae were involved in 70 cases and three vertebrae were involved in 8 cases. All of the cases complicated by nerve function damage in different extent before operation. The patients were followed up regularly after operation. The pain score (visual analogue score, VAS), nerve function Frankel classification, effectiveness evaluation, and the blind test evaluation of X-ray and MRI were performed.
All 78 cases were followed up 12 to 30 months (mean, 26 months). No sinus tract and recurrence occurred. The VAS scores were significantly improved at 1 month (2.4 +/- 0.3), 3 months (1.0 +/- 0.2), 6 months (0.5 +/- 0.4), and 12 months (0) when compared with preoperative score (9.2 +/- 0.6) (P < 0.05). The nerve function Frankel classification after operation was significantly improved when compared with preoperative one (P < 0.05); the patients in grade C and grade D had the most obvious improvement. The effectiveness evaluation indicated no aggravated cases. As time went on, the improved and unchanged patients were cured gradually and the improvement rate and the curative rate were 100% and 91.03%, respectively at 12 months after operation. The imaging scores were significantly improved at 1 month (4.11 +/- 0.09), 3 months (4.68 +/- 0.04), 6 months (4.92 +/- 0.08), and 12 months (5) when compared with the preoperative score (0.17 +/- 0.03) (P < 0.05).
One-stage radical debridement combined with posterior pedicle internal fixation is an ideal therapeutic method for brucellar spondylitis of the thoracic and lumbar vertebrae, which has obvious superiority in pain relief, the spine stability, the nerve function recovery, and early rehabilitation.
探讨布鲁氏菌性脊柱炎的手术治疗方法及疗效。
2002年1月至2010年10月，78例确诊为胸腰椎布鲁氏菌性脊柱炎的患者接受了一期病灶清除加后路椎弓根内固定术。其中男性42例，女性36例，年龄24至65岁（平均45岁）。病程8至29个月（平均12个月）。累及两个椎体70例，累及三个椎体8例。所有病例术前均合并不同程度神经功能损害。术后对患者进行定期随访。进行疼痛评分（视觉模拟评分法，VAS）、神经功能Frankel分级、疗效评价以及X线和MRI的盲法评估。
78例患者均获随访12至30个月（平均26个月）。无窦道形成及复发。与术前评分（9.2±0.6）相比，术后1个月（2.4±0.3）、3个月（1.0±0.2）、6个月（0.5±0.4）及12个月（0）时VAS评分显著改善（P<0.05）。术后神经功能Frankel分级与术前相比显著改善（P<0.05）；C级和D级患者改善最明显。疗效评价显示无病情加重病例。随着时间推移，改善及未变化的患者逐渐治愈，术后12个月时改善率和治愈率分别为100%和91.03%。与术前评分（0.17±0.03）相比，术后1个月（4.11±0.09）、3个月（4.68±0.04）、6个月（4.92±0.08）及12个月（5）时影像学评分显著改善（P<0.05）。
一期病灶清除联合后路椎弓根内固定术是胸腰椎布鲁氏菌性脊柱炎的理想治疗方法，在缓解疼痛、脊柱稳定性、神经功能恢复及早期康复方面具有明显优势。
