Zheng Qi, Jin Yang-Hui, Ying Xiao-Zhang, Wang Yi-Fan, Shi Shi-Yuan, Zhu Bo
Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou 310003, Zhejiang, China.
Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou 310003, Zhejiang, China;
Zhongguo Gu Shang. 2018 Apr 25;31(4):361-367. doi: 10.3969/j.issn.1003-0034.2018.04.012.
To evaluate the clinical value of percutaneous endoscopic focal cleaning and drainage in the treatment of single-level suppurative spondylitis.
The clinical data of 18 patients with single-level suppurative spondylitis treated by percutaneous endoscopic focal cleaning and drainage from June 2014 to December 2015 were retrospectively analyzed. There were 11 males and 7 females, aged from 46 to 75 years old with an average of (58.89±9.46) years. According to the patient's diagnosis and drug sensitivity results to anti-infection therapy after operation. All the patients were followed up for 12 to 24 months with an average of(15.50±3.45) months. Disease control status was evaluated by laboratory examination of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) before and after operation. Relief of pain was evaluated using visual analogue scale(VAS). Nerve function was assessed by ASIA classification. Clinical effects were evaluated by Kirkaldy-Willis standard. Spinal stability and recurrence of infection were observed by imaging data.
All the operations were successful, and no complication as hematoma, nerve injury, infection, cerebrospinal fluid leakage, sinus formation at the site of tube placement, or mixed infection were found. Postoperative bacteriological report was positive in 12 cases, while 6 cases showed no bacterial growth, and the infection status in 13 cases were confirmed by pathological examination. ESR, CRP, VAS at 2 weeks, 3 months after surgery and at the final follow-up were obviously improved(<0.05). Clinical symptoms were improved significantly at 1 week to 3 months after operation. According to Kirkaldy-Willis standard to evaluate the clinical effect, 14 cases obtained excellent results, 3 good, and 1 fair. Nerve function recovery was based on ASIA grading at the final follow-up. The lost Cobb angles were (1.11±1.18)° on average, with no statistically significant difference before and after operation (>0.05). During the follow-up, no recurrent infection has occurred.
Percutaneous endoscopic focal cleaning and drainage is a minimally invasive, effective and safe surgical method, which serves as a new choice for surgical treatment of suppurative spondylitis.
评估经皮内镜病灶清理及引流术治疗单节段化脓性脊柱炎的临床价值。
回顾性分析2014年6月至2015年12月采用经皮内镜病灶清理及引流术治疗的18例单节段化脓性脊柱炎患者的临床资料。其中男性11例，女性7例，年龄46～75岁，平均（58.89±9.46）岁。术后根据患者诊断及药敏结果进行抗感染治疗。所有患者均随访12～24个月，平均（15.50±3.45）个月。通过术前、术后红细胞沉降率（ESR）、C反应蛋白（CRP）实验室检查评估疾病控制情况。采用视觉模拟评分法（VAS）评估疼痛缓解情况。通过美国脊髓损伤协会（ASIA）分级评估神经功能。按照Kirkaldy-Willis标准评估临床疗效。通过影像学资料观察脊柱稳定性及感染复发情况。
所有手术均成功，未发现血肿、神经损伤、感染、脑脊液漏、置管部位窦道形成或混合感染等并发症。术后细菌学报告12例阳性，6例无细菌生长，13例感染情况经病理检查确诊。术后2周、3个月及末次随访时ESR、CRP、VAS均明显改善（P<0.05）。术后1周～3个月临床症状明显改善。按照Kirkaldy-Willis标准评估临床疗效，优14例，良3例，可1例。末次随访时神经功能恢复情况依据ASIA分级。平均丢失Cobb角为（1.11±1.18）°，手术前后比较差异无统计学意义（P>0.05）。随访期间未发生感染复发。
经皮内镜病灶清理及引流术是一种微创、有效且安全的手术方法，为化脓性脊柱炎的手术治疗提供了新的选择。
