摘要
目的 观察一期前路病灶清除、自体髂骨植骨融合、单边钉棒系统内固定治疗布鲁氏菌性脊柱炎的临床疗效。方法 回顾性分析自2020-01-2023-03采用一期前路病灶清除、自体髂骨植骨融合、单边钉棒系统内固定治疗的36例布鲁氏菌性脊柱炎,比较手术前后疼痛VAS评分、ODI指数、红细胞沉降率、C-反应蛋白。末次随访时评估脊髓神经功能ASIA分级,采用Lee改良放射学标准评估植骨融合情况。结果 36例均获得至少12个月随访,术后所有患者全身症状和腰背部疼痛明显改善。随访期间未出现切口不愈合、继发感染、钉棒系统内固定失败、神经功能恶化等严重并发症。末次随访时影像学检查结果显示所有患者获得理想的椎间骨性融合。术前5例ASIA C级,1例末次随访时恢复至D级,4例末次随访时恢复至E级;术前19例ASIA D级,术后第3个月恢复至E级。术后1个月疼痛VAS评分、ODI指数较术前明显降低,且术后3、6、12个月持续降低,差异有统计学意义(P<0.05)。术后1个月红细胞沉降率、C-反应蛋白较术前明显降低,且术后3、6个月持续降低,术后6个月降至正常水平,差异有统计学意义(P<0.05)。结论 采用一期前路病灶清除、自体髂骨植骨融合、单边钉棒系统内固定手术治疗布鲁氏菌性脊柱炎可以彻底清除病灶组织,明显改善患者疼痛症状,重建脊柱稳定性并获得满意的植骨融合效果。
Objective To observe the clinical efficacy of one-stage anterior focus debridement,autogenous iliac bone graft and fusion with unilateral screw rod system internal fixation in the treatment of brucellosis spondylitis.Methods Thirty-six cases of brucellosis spondylitis were treated with one-stage anterior debridement,autogenous iliac bone graft and fusion with unilateral screw rod system internal fixation from January 2020 to March 2023.The pain VAS score,ODI index,erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were compared before and after operation.At the final follow-up,the spinal cord neuro-logical function was evaluated according to ASIA grade,and the bone graft fusion was evaluated by Lee modified radiological cri-teria.Results All the 36 patients were followed up for at least 12 months.The systemic symptoms and low back pain of all pa-tients were significantly improved after operation.During the follow-up period,there were no serious complications such as inci-sion nonunion,secondary infection,internal fixation failure of screw rod system and deterioration of neurological function.The results of imaging examination at the last follow-up showed that all patients achieved ideal intervertebral fusion.Of 5 cases of ASIA grade C before operation,1 case recovered to grade D at the last follow-up,and 4 cases recovered to grade E at the last fol-low-up;19 cases ASIA grade D before operation,recovered to E grade 3 months after operation.The pain VAS score and ODI index at 1 month after operation were significantly lower than those before operation,and decreased continuously at 3,6 and 12 months after operation.One month after operation,erythrocyte sedimentation rate and C-reactive protein were significantly low-er than those before operation,and decreased continuously at 3 and 6 months after operation,and decreased to normal level at 6 months after operation,the difference was statistically significant(P<0.05).Conclusion One-stage anterior debridement,au-togenous iliac bone graft and fusion with unilateral screw rod system internal fixation the treatment of brucellosis spondylitis can completely remove the pathological tissue,significantly improve the pain symptoms of the patients,reconstruct the stability of the spine and obtain satisfactory results of bone graft fusion.
作者
徐清泉
朱宗波
刘科保
汤海
赵奎
吉克阿木
郑烨
XU Qingquan;ZHU Zongbo;LIU Kebao;TANG Hai;ZHAO Kui;JIKe Amu;ZHENG Ye(Department of Orthopedics,Liangshan Yi Autonomous Prefecture first People's Hospital,Xichang,Sichuan 615000,China)
出处
《中国骨与关节损伤杂志》
2025年第1期33-37,共5页
Chinese Journal of Bone and Joint Injury
关键词
布鲁氏菌
脊柱炎
前路手术
植骨融合
单边钉棒系统
内固定
Brucellosis
Spondylitis
Anterior approach surgery
Bone graft fusion
Unilateral screw rod system
Internal fixation
