腰椎布氏杆菌病侧前与后路病灶清除固定比较△（开放获取）

(Open Access) Anterolateral versus posterior debridement and instrumented fusion for lumbar brucellus spondylitis

摘要:

[目的] 比较经腰三角入路侧前入路与后路病灶清除固定融合治疗腰椎布氏杆菌性脊柱炎（lumbar brucellus spondyli-tis, LBS） 的临床效果。[方法] 回顾性分析2017 年1 月—2022 年10 月收治的102 例LBS 患者的临床资料，根据医患沟通结果，46 例采用经腰三角侧前入路手术（侧前组），56 例采用后路手术（后路组）。比较两组围手术期、随访及影像结果。[结果] 两组患者均顺利完成手术，侧前组手术时间[(163.0±15.4) min vs (200.4±22.6) min, P＜0.001]、切口长度[(13.0±1.5) cm vs (15.5±2.0) cm, P＜0.001]、术中失血量[(233.0±26.8) ml vs (350.2±30.7) ml, P＜0.001]、术后下地时间[(3.0±0.5) d vs (4.0±0.8) d, P＜0.001] 与住院时间[(8.6±2.0) d vs (12.5±2.2) d, P＜0.001] 均显著优于后路组。侧前组完全负重活动时间显著早于后路组[(96.2±7.3) d vs (100.0±10.5) d, P=0.041] 。随时间推移，两组术后VAS、ODI、JOA 评分及ASIA 分级均显著改善（P＜0.05），术后3 d 侧前组VAS 评分显著优于后路组（P＜0.05）；术后3 d、末次随访时，侧前组ODI、JOA 评分均显著优于后路组（P＜0.05）。辅助检查方面，术后3 d侧前组CRP [(20.5±7.8) mg/L vs (24.8±8.0) mg/L, P=0.008]、ESR [(30.2±9.0) mm/h vs (34.5±10.2) mm/h, P=0.028] 水平均显著低于后路组。[结论] 相比后路手术，经腰三角侧前入路手术治疗LBS 具有创伤小、术后下地时间早、腰椎功能改善好的优点，安全可行。

Abstract:

[Objective] To compare the clinical efficacy of debridement and instrumented fusion through anterolateral approach at thelumbar triangle versus conventional posterior approach for lumbar brucellus spondylitis (LBS). [Methods] A retrospective study was conduct-ed on 102 patients who received surgical treatment for LBS in our hospital from January 2017 to October 2022. According to doctor-patientcommunication, 46 patients had operation performed through anterolateral approach at the lumbar triangle (the AL group), while other 56 cas-es were operated through conventional posterior approach (the CP group). The documents regarding to perioperative period, follow-up andimages were compared between the two groups. [Results] All patients in both groups successfully completed the operation. The AL groupproved significantly superior to the CP group in terms of operation time [(163.0±15.4) min vs (200.4±22.6) min, P＜0.001], incision length[(13.0±1.5) cm vs (15.5±2.0) cm, P＜0.001], intraoperative blood loss [(233.0±26.8) ml vs (350.2±30.7) ml, P＜0.001], postoperative ambula-tion time [(3.0±0.5) days vs (4.0±0.8) days, P＜0.001] and hospital stay [(8.6±2.0) days vs (12.5±2.2) days, P＜0.001]. In addition, the formerresumed full weight-bearing activity significantly earlier than the latter [(96.2±7.3) days vs (100.0±10.5) days, P=0.041]. The VAS, ODI,JOA scores and ASIA grades in both groups were significantly improved over time (P＜0.05), and the AL group was significantly better thanthe CP group in VAS scores 3 days postoperatively (P＜0.05), as well as ODI and JOA scores 3 days after operation and at the latest follow-up(P＜0.05). In terms of blood tests, the AL group had significantly lower CRP [(20.5±7.8) mg/L vs (24.8±8.0) mg/L, P=0.008] and ESR [(30.2±9.0) mm/h vs (34.5±10.2) mm/h, P=0.028] than the CP group 3 days postoperatively. [Conclusion] Compared with posterior surgery, the an-terolateral operation at the lumbar triangular for LBS with advantages of less trauma, earlier postoperative ambulation and better improve-ment of lumbar function, is a safe and feasible surgical technique.