下腰椎布鲁氏杆菌性脊柱炎的椎间孔镜治疗△

Transforaminal endoscopic debridement of the lesion of brucellosis spondylitis in the lower lumbar spine

摘要:

[目的]评价椎间孔镜治疗下腰椎(L4/5、L5S1)布鲁氏杆菌性脊柱炎的疗效及手术安全性。[方法]回顾性分析本院脊柱外科 2014 年 1 月—2022 年 8 月应用椎间孔镜治疗下腰椎布鲁氏杆菌性脊柱炎 16 例患者的临床资料。总结患者临床与检验资料。[结果]16 例患者均顺利完成手术，无神经、硬膜损伤等并发症。术后腰痛及下肢神经症状明显减轻，切口愈合良好。 体温由术前 (38.6±1.2)℃，下降至术后 2 d (37.6±0.7)℃，末次随访时 (36.5±0.4)℃ (P＜0.05)；疼痛 VAS 评分显著下降 [(6.3±1.3), (3.7±1.2), (1.1±0.9), P＜0.05]；ODI 评分评分显著下降 [(67.4±9.5)%, (36.1±6.1)%, (12.3±4.1)%, P＜0.05]；而 JOA 评分则显著增加 [(8.9±3.0), (14.5±3.9), (25.6±1.6), P＜0.05]。检验方面，ESR 由术前 (51.9±33.3) mm/h，显著下降至术后 2 d (34.3±16.0) mm/h，末次随访时(10.6±4.2)mm/h(P＜0.05)；CRP 亦显著下降 [(46.6±34.0)mg/L, (30.2±18.9)mg/L, (3.0±1.4)mg/L, P＜0.05]。[结论]椎间孔镜治疗腰椎布鲁氏杆菌性脊柱炎手术创伤小，安全性高，临床结果满意。

Abstract:

[Objective] To evaluate the efficacy and surgical safety of transforaminal endoscopic debridement of the lesion of brucellosis spondylitis in the lower lumbar spine (L4/5, L5 S1) . [Methods] A retrospective study was conducted on 16 patients who underwent transforami- nal endoscopic debridement of the lesion of brucellosis spondylitis in the lower lumbar spine from January 2014 to August 2022. Clinical and laboratory data of patients were summarized. [Results] All the patients had operation performed successfully with no complications such as nerve and dural injury, got significantly relief of lumbago and nerve symptoms of lower extremity and well incision healing postoperatively. The body temperature decreased from (38.6±1.2)℃ before surgery to (37.6±0.7)℃ 2 days after surgery and (36.5±0.4)℃ at the last follow-up (P＜0.05); the VAS score for pain significantly decreased [(6.3±1.3), (3.7±1.2), (1.1±0.9), P＜0.05]; the ODI score significantly decreased [(67.4±9.5)%, (36.1±6.1)%, (12.3±4.1)%, P＜0.05] . However, the JOA score significantly increased from (8.9±3.0) to (14.5±3.9) and (25.6± 1.6) (P＜0.05) . In terms of laboratory test, the ESR significantly decreased from (51.9±33.3) mm/h preoperatively to (34.3±16.0) mm/h 2 days postoperatively, and (10.6±4.2) mm/h at the latest follow-up (P＜0.05) . CRP decreased significantly from (46.6±34.0) mg/L to (30.2±18.9) mg/L and postoperative (3.0±1.4) mg/L accordingly (P＜0.05) . [Conclusion] This transforaminal endoscopic debridement of the lesion of brucellosis spondylitis in the lower lumbar spine is less invasive, safer and has satisfactory clinical results.