单节段布氏杆菌脊柱炎病灶清除经病椎固定融合△

Debridement and instrumented fusion of the affected vertebrae for single- segment brucellar spondylitis

摘要:

[目的] 探讨后路行病灶清除，病椎置钉，椎间植骨融合内固定手术治疗腰椎单节段布氏杆菌脊柱炎的临床疗效。 [方法] 回顾性分析 2016 年 11 月—2019 年 12 月，采用上述术式治疗 21 例腰椎单节段布氏杆菌脊柱炎患者的临床资料。[结果]所有患者均顺利完成手术，术中无严重并发症。平均随访时间(18.8±3.4)个月，随时间推移，VAS 评分和 ODI 指数均显著减少(P＜0.05)，而 JOA 评分显著增加(P＜0.05)。21 例患者术后病理 HE 染色均可见病变区有大量单核细胞、淋巴细胞等炎性细胞浸润，符合布鲁氏菌病改变，Gimesa 染色均发现短球状布鲁氏菌。与术前相比，术后 ESR、CRP 和局部后凸 Cobb 角均显著降低(P＜0.05)，而椎间隙高度显著增加(P＜0.05)。末次随访时，影像学显示所有患者均获得骨性融合，未出现内固定松动、断裂等情况。[结论]后路病灶清除，病椎置钉椎间融合内固定可安全有效治疗腰椎单节段布氏杆菌脊柱炎。

Abstract:

[Objective] To investigate the clinical efficacy of debridement and instrumented fusion of affected vertebrae through the pos- terior approach for single- segment brucellar spondylitis. [Methods] A retrospective study was performed on 21 patients who underwent abovementioned surgical treatment for single-segment brucellar spondylitis from November 2016 to December 2019. [Results] All the pa- tients had operation conducted successfully without serious complications. As time went in the follow-up lasted for (18.8±3.4) months, the VAS and ODI scores decreased significantly (P＜0.05) , while JOA score increased significantly (P＜0.05) . In term of pathological biopsy, a large number of monocytes, lymphocytes and other inflammatory cells were found in the lesion area by HE staining in the 21 patients, which was consistent with brucellosis. In addition, Gimesa staining found brucellosis bacillus. The ESR, CRP and local kyphotic Cobb angle were significantly decreased (P＜0.05) , while the intervertebral space height significantly increased postoperatively compared with those preopera- tively (P＜0.05) . At the latest follow-up, imaging showed that all patients obtained bone fusion, without implant loosening or fracture. [Conclusion] The debridement and instrumented fusion of affected vertebrae through the posterior approach are safe and effective treatment for single-segment lumbar brucellar spondylitis.