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经皮内镜下病灶清除及融合术治疗化脓性腰椎间盘炎：手术技术及与经皮内镜下引流和病灶清除术的比较

Percutaneous Endoscopic Interbody Debridement and Fusion for Pyogenic Lumbar Spondylodiskitis: Surgical Technique and the Comparison With Percutaneous Endoscopic Drainage and Debridement.

作者信息

Lai Po-Ju, Wang Sheng-Fen, Tsai Tsung-Ting, Li Yun-Da, Chiu Ping-Yeh, Hsieh Ming-Kai, Kao Fu-Cheng

机构信息

Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.

Department of Anesthesiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

出版信息

Neurospine. 2021 Dec;18(4):891-902. doi: 10.14245/ns.2142640.320. Epub 2021 Dec 31.

DOI:10.14245/ns.2142640.320
PMID:35000347
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8752711/
Abstract

OBJECTIVE

Surgical treatment of severe infectious spondylodiskitis remains challenging. Although minimally invasive percutaneous endoscopic drainage and debridement (PEDD) may yield good results in complicated cases, outcomes of patients with extensive structural damage and mechanical instability may be unsatisfactory. To address severe infectious spondylodiskitis, we have developed a surgical technique called percutaneous endoscopic interbody debridement and fusion (PEIDF), which comprises endoscopic debridement, bonegraft interbody fusion, and percutaneous posterior instrumentation.

METHODS

Outcomes of PEIDF in 12 patients and PEDD in 15 patients with infectious spondylodiskitis from April 2014 to July 2018 were reviewed retrospectively. Outcome were compared between 2 kinds of surgical procedures.

RESULTS

Patients in PEIDF group had significantly lower rate of revision surgery (8.3% vs. 58.3%), better kyphosis angle (-5.73° ± 8.74 vs. 1.07° ± 2.70 in postoperative; 7.09° ± 7.23 vs. 0.79° ± 4.08 in kyphosis correction at 1 year), and higher fusion rate (83.3% vs. 46.7%) than those who received PEDD.

CONCLUSION

PEIDF is an effective approach for treating infectious spondylodiskitis, especially in patients with spinal instability and multiple medical comorbidities.

摘要

目的

严重感染性椎间盘炎的手术治疗仍然具有挑战性。尽管微创经皮内镜引流及清创术（PEDD）在复杂病例中可能产生良好效果，但对于结构广泛受损和存在机械性不稳定的患者，其治疗效果可能并不理想。为应对严重感染性椎间盘炎，我们开发了一种名为经皮内镜椎间清创融合术（PEIDF）的手术技术，该技术包括内镜清创、椎间植骨融合以及经皮后路内固定。

方法

回顾性分析2014年4月至2018年7月期间12例行PEIDF手术和15例行PEDD手术的感染性椎间盘炎患者的治疗结果。比较两种手术方式的治疗效果。

结果

与接受PEDD手术的患者相比，PEIDF组患者的翻修手术率显著更低（8.3% 对58.3%），后凸角更好（术后分别为-5.73°±8.74对1.07°±2.70；术后1年的后凸矫正分别为7.09°±7.23对0.7°±4.08），融合率更高（83.3%对46.7%）。

结论

PEIDF是治疗感染性椎间盘炎的一种有效方法，尤其适用于存在脊柱不稳定和多种内科合并症的患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0af/8752711/a37a48b06eab/ns-2142640-320f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0af/8752711/e9216fec8cb9/ns-2142640-320f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0af/8752711/c169670dbea6/ns-2142640-320f2.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0af/8752711/b7db801d0ab0/ns-2142640-320f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0af/8752711/a37a48b06eab/ns-2142640-320f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0af/8752711/e9216fec8cb9/ns-2142640-320f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0af/8752711/c169670dbea6/ns-2142640-320f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0af/8752711/f4073590a6f0/ns-2142640-320f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0af/8752711/b7db801d0ab0/ns-2142640-320f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0af/8752711/a37a48b06eab/ns-2142640-320f5.jpg

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