布氏菌腰椎炎UBE辅助与开放后路病灶清除融合术△

Unilateral biportal endoscopic debridement and instrumented fusion versus open counterparts for lumbar brucellosis spondylitis

摘要:

[目的] 比较单侧双通道内镜（unilateral biportal endoscopy, UBE） 与开放后路病灶清除椎间融合治疗椎间盘炎型腰椎布鲁氏菌性脊柱炎（lumbar brucellosis spondylitis, LBS） 的临床疗效。[方法] 回顾性分析经手术治疗获得完整随访的34 例单间隙椎间盘炎型LBS 患者。后期的16 例患者采用UBE 辅助下后路椎间隙病灶清除引流，经皮椎弓根钉内固定（UBE 组）；而早期的18 例患者行腰椎后路脊柱感染病灶清除，椎弓根钉内固定（开放组）。比较两组围手术期、随访、影像学结果。[结果] 两组患者均顺利完成手术，UBE 组手术时间[(191.3±18.6) min vs (143.3±34.4) min, P＜0.001]、术中透视次数[(5.6±1.0) 次vs(2.4±0.8) 次, P＜0.001] 显著大于开放组；但前者切口长度[(5.4±0.3) cm vs (14.8±0.9) cm, P＜0.001]、术中失血量[(185.7±18.1) mL vs(261.9±17.9) mL, P＜0.001]、下地行走时间[(2.1±0.4) d vs (5.4±0.6) d, P＜0.001] 及住院时间[(8.8±3.0) d vs (13.7±7.2) d, P=0.017] 显著优于后者。所有患者均获12 个月以上随访，术后随时间推移，两组VAS、ODI、JOA 评分均显著改善（P＜0.05）。术后1 个月，UBE 组的VAS 评分[(1.8±0.7) vs (4.1±0.6), P＜0.001]、ODI 评分[(32.2±7.0) vs (40.5±4.6), P＜0.001]、JOA 评分[(20.2±1.7) vs (17.2±1.0), P＜0.001] 均显著优于开放组。辅助检查方面，术后两组ESR、CRP 均显著减少（P＜0.05），椎间隙高度、Cobb 角显著改善（P＜0.05），相应时间点，两组上述指标的差异均无统计学意义（P＞0.05）。末次随访时，两组Bridwell 分级差异无统计学意义（P＞0.05）。[结论] UBE 辅助下手术治疗椎间盘炎型LBS 具有术后早期疼痛轻、术中失血量少、术后住院时间短等优点。

Abstract:

[Objective] To compare the clinical consequence of unilateral biportal endoscopic (UBE) debridement and instrumented fu-sion versus open debridement and instrumented fusion for lumbar brucellosis spondylitis (LBS). [Methods] A retrospective research wasdone on 34 patients who received surgical treatment for single-segment LBS and were followed up after surgery. Of them, 16 patients in thelater stage were treated with UBE-assisted posterior debridement and drainage combined with interbody bone allografting and antibrucello-sis drugs, as well as percutaneous pedicle screw fixation (the UBE group), while 18 patients in the early stage underwent the open counter-parts (the open group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in bothgroups had corresponding surgical procedures conducted smoothly. Although the UBE group consumed significantly longer operative time[(191.3±18.6) min vs (143.3±34.4) min, P＜0.001] and more intraoperative fluoroscopy times [(5.6±1.0) vs (2.4±0.8), P＜0.001] than the opengroup, the former proved significantly superior to the latter in terms of incision length [(5.4±0.3) cm vs (14.8±0.9) cm, P＜0.001], intraopera-tive blood loss [(185.7±18.1) mL vs (261.9±17.9) mL, P＜0.001], bed rest time [(2.1±0.4) days vs (5.4±0.6) days, P＜0.001] and hospital stay[(8.8±3.0) days vs (13.7±7.2) days, P=0.017]. All patients were followed up for more than 12 months, and the VAS, ODI and JOA scores inboth groups were significantly improved over time (P＜0.05). The UBE group was significantly better than the open group regarding to VASscore [(1.8±0.7) vs (4.1±0.6), P＜0.001], ODI score [(32.2±7.0) vs (40.5±4.6), P＜0.001], JOA score [(20.2±1.7) vs (17.2±1.0), P＜0.001] 1month postoperatively. As for auxiliary examination, the ESR and CRP were significantly decreased (P＜0.05), and vertebral space height andlumbar lordotic angle were significantly improved in both groups after surgery (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). At the last follow-up, there was no significant difference in Bridwell fusionscale between the two groups (P＞0.05). [Conclusion] UBE assisted debridement and instrumented fusion for disc type LBS has the advantag-es of less pain in the early postoperative period, less intraoperative blood loss, and shortening postoperative hospital stay over the open coun-terparts.