Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, 410008, Hunan, China.
Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, 410008, Hunan, China.
Sci Rep. 2023 Oct 4;13(1):16684. doi: 10.1038/s41598-023-43812-5.
This retrospective study aimed to compare the clinical efficacy of the posterior procedure with the combined anterior and posterior procedure in the surgical management of lumbar Brucella spondylitis. From January 2015 to June 2020, a total of 62 patients presenting with lumbar Brucella spondylitis underwent either one-stage posterior pedicle fixation, debridement, and interbody fusion (Group A, n = 33) or anterior debridement, bone grafting, and posterior instrumentation (Group B, n = 29). All patients were followed up for an average of 25.4 ± 1.5 months and achieved complete resolution of lumbar Brucella spondylitis. No significant differences between the groups were observed in terms of age or pre-operative, three-month postoperative and final follow-up indices of the VAS, ESR, CRP, lordosis angle, ODI scores, fusion time, and time of serum agglutination test conversion to negative (P > 0.05). Each patient exhibited notable improvements in neurological function, as assessed by the JOA score rating system. Group A demonstrated significantly shorter operative duration, intraoperative blood loss, and hospital stay compared to Group B (P < 0.05). Superficial wound infection was observed in one case in Group A, whereas Group B experienced one case each of intraoperative peritoneal rupture, postoperative ileus, iliac vein injury, and superficial wound infection. This study supports the efficacy of both surgical interventions in the treatment of lumbar Brucella spondylitis, with satisfactory outcomes. However, the posterior approach demonstrated advantages, including reduced surgical time, diminished blood loss, shorter hospital stays, and fewer perioperative complications. Consequently, the one-stage posterior pedicle fixation, debridement, and interbody fusion represent a superior treatment option.
本回顾性研究旨在比较后路手术与前后路联合手术治疗腰椎布鲁氏菌病的临床疗效。2015 年 1 月至 2020 年 6 月，共 62 例腰椎布鲁氏菌病患者接受一期后路椎弓根固定、清创、椎间融合（A 组，n=33）或前路清创、植骨、后路内固定（B 组，n=29）治疗。所有患者平均随访 25.4±1.5 个月，腰椎布鲁氏菌病完全缓解。两组患者在年龄、术前、术后 3 个月及末次随访时的视觉模拟评分（VAS）、红细胞沉降率（ESR）、C 反应蛋白（CRP）、后凸角、Oswestry 功能障碍指数（ODI）评分、融合时间、血清凝集试验转阴时间等方面差异均无统计学意义（P>0.05）。两组患者的神经功能均有显著改善，JOA 评分系统评估。A 组的手术时间、术中出血量和住院时间明显短于 B 组（P<0.05）。A 组有 1 例发生浅表伤口感染，B 组有 1 例发生术中腹膜破裂、术后肠梗阻、髂静脉损伤和浅表伤口感染。本研究支持两种手术干预方法治疗腰椎布鲁氏菌病的疗效，均取得满意的结果。然而，后路手术具有手术时间短、术中出血少、住院时间短、围手术期并发症少等优点。因此，一期后路椎弓根固定、清创、椎间融合是一种较好的治疗选择。
