Kou Xian-Shuai, She Wei, Ma Gui-Fu, Pu Xing-Yu, Wu Yun-Biao, Qi Yang, Luo Wen-Yuan
The First Clinical Medical College, Gansu University of Chinese Medicine, Gansu Provincial Hospita, Lanzhou 730000, Gansu, China.
Department of Orthopaedics, Gansu Provincial Hospital, Lanzhou 730000, Gansu, China.
Zhongguo Gu Shang. 2024 Aug 25;37(8):764-71. doi: 10.12200/j.issn.1003-0034.20230255.
To explore the clinical efficacy and safety of one-stage posterior lesion removal and internal spinal fixation in patients with lumbar Brucellosis spondylitis.
The clinical data of 24 patients admitted from October 2017 to October 2022 were retrospectively analyzed, 2 patients were lost to follow-up at 10 months after surgery, at the final 22 cases were included in the study, including 13 males and 9 females with an average age of (52.00±6.89) years old, were treated with one-stage posterior lesion removal and internal spinal fixation. The operation time, intraoperative bleeding, follow-up time, erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) before and after operation were recorded. The pain visual analogue scale(VAS), Oswestry disability index(ODI), the Japanese Orthopaedic Association(JOA) score for neurofunction, American Spinal Injury Association(ASIA) spinal cord injury grade and modified MacNab criteria were ussed to evaluate the efficacy.
All patients were followed up from 12 to 30 months with an average of (17.41±4.45) months. The operation time was 70 to 155 min with an average of (116.59±24.32) min;the intraoperative bleeding volume was 120 to 520 ml with an average of (275.00±97.53) ml. CRP and ESR levels decreased more significantly at 1 week and at the final follow-up than preoperative levels(<0.05). VAS, JOA score and ODI at 1 week and at the latest follow-up were more significantly improved than preoperative results(<0.05). There was no significant difference between ASIA preoperative and 1 week after operation(>0.05), and a significant difference between preoperative and last follow-up(<0.05). In the final follow-up, 21 patients had excellent efficacy, 1 patient had fair, and there was no recurrence during the follow-up.
One-stage transpedicular lesion removal and internal spinal fixation, with few incisions and short operation time, helps the recovery of neurological function, and the prognosis meets the clinical requirements, which can effectively control Brucella spondylitis.
探讨一期后路病灶清除并椎间植骨融合内固定术治疗腰椎布鲁氏菌性脊柱炎的临床疗效及安全性。
回顾性分析2017年10月至2022年10月收治的24例腰椎布鲁氏菌性脊柱炎患者的临床资料，术后10个月失访2例，最终纳入研究22例，其中男13例，女9例，平均年龄（52.00±6.89）岁，均采用一期后路病灶清除并椎间植骨融合内固定术治疗。记录手术时间、术中出血量、随访时间、术前及术后红细胞沉降率（ESR）和C反应蛋白（CRP）水平。采用疼痛视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）、日本骨科学会（JOA）神经功能评分、美国脊髓损伤协会（ASIA）脊髓损伤分级及改良MacNab标准评价疗效。
所有患者均获随访，随访时间12～30个月，平均（17.41±4.45）个月。手术时间70～155 min，平均（116.59±24.32）min；术中出血量120～520 ml，平均（275.00±97.53）ml。术后1周及末次随访时CRP和ESR水平较术前明显降低（P<0.05）。术后1周及末次随访时VAS、JOA评分及ODI较术前明显改善（P<0.05）。ASIA分级术前与术后1周比较差异无统计学意义（P>0.05），术前与末次随访比较差异有统计学意义（P<0.05）。末次随访时，疗效优21例，良1例，随访期间无复发。
一期后路病灶清除并椎间植骨融合内固定术治疗腰椎布鲁氏菌性脊柱炎，切口小，手术时间短，有利于神经功能恢复，预后满足临床要求，能有效控制布鲁氏菌性脊柱炎。
