Liu Changhao, Liu Qiang, Zheng Jianping, Niu Ningkui, Shi Jiandang, Yang Zongqiang
Department of Orthopedics, Zhangye People's Hospital Affiliated to Hexi University, Zhangye, Gansu, China.
The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China.
Front Surg. 2024 Mar 22;11:1365498. doi: 10.3389/fsurg.2024.1365498. eCollection 2024.
This study aims to investigate the treatment strategies for lumbar brucellar spondylitis by comparing the outcomes of pure pharmacological treatment with diseased intervertebral fixation fusion, with or without lesion clearance.
A total of 157 patients with lumbar brucellar spondylitis were categorized into three groups: Group A (52 cases) received pure pharmacological treatment, Group B (53 cases) underwent posterior vertebral fixation fusion, and Group C (52 cases) received posterior (or anterior) lesion clearance followed by posterior vertebral fixation fusion. Clinical data were analyzed, and the efficacy of the three treatment methods was evaluated.
The surgical groups showed better outcomes at various time points compared to the pharmacological treatment group ( < 0.05). The pure fixation group outperformed the lesion clearance fusion group during the perioperative period ( < 0.05). The ESR, CRP, ODI scores, imaging evaluation and complications of the lesion clearance followed by fixation group were all better than those of the other two groups ( < 0.05). Surgical treatment groups showed no statistically significant difference in VAS scores ( > 0.05), and both were superior to the pharmacological treatment group. There were no statistically significant differences in clinical efficacy among the three groups at the last follow-up.
Surgical treatment achieves early recovery goals compared to pharmacological treatment for brucellar spondylitis. However, individualized treatment principles should guide surgical decisions to select the most suitable approach for patients.
本研究旨在通过比较单纯药物治疗与病变椎间固定融合（有无病灶清除）的疗效，探讨腰椎布鲁氏菌性脊柱炎的治疗策略。
将157例腰椎布鲁氏菌性脊柱炎患者分为三组：A组（52例）接受单纯药物治疗，B组（53例）接受后路椎体固定融合术，C组（52例）接受后路（或前路）病灶清除后再行后路椎体固定融合术。分析临床资料，评估三种治疗方法的疗效。
与药物治疗组相比，手术组在各个时间点的疗效均更好（P＜0.05）。单纯固定组在围手术期的表现优于病灶清除融合组（P＜0.05）。病灶清除后固定组的血沉、C反应蛋白、ODI评分、影像学评估及并发症均优于其他两组（P＜0.05）。手术治疗组的视觉模拟评分无统计学差异（P＞0.05），且均优于药物治疗组。末次随访时，三组临床疗效无统计学差异。
与布鲁氏菌性脊柱炎的药物治疗相比，手术治疗可实现早期康复目标。然而，应遵循个体化治疗原则指导手术决策，为患者选择最合适的治疗方法。
