Objective:To investigate the short-term and medium-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of Brucella spondylitis of the l...Objective:To investigate the short-term and medium-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of Brucella spondylitis of the lumbar spine.Method:156 cases of Brucella spondylitis of lumbar spine were selected and divided into experimental group(n=80)and combined group(n=76)according to different surgical methods.The experimental group was treated with one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation.The combined group was treated with one-stage anterior debridement and intertransverse process bone grafting combined with posterior internal fixation.The operative indexes and clinical effects were compared between the two groups.Result:The operation time,intraoperative bleeding volume and time of landing after operation in the experimental group were less than those in the combined group,with statistical significance(P<0.05).VAS score,ODI index,Cobb angle and Frankel grade of nervous function in the two groups were significantly improved after 3 months and 36 months of treatment(P<0.05),but there was no significant difference between the two groups at the same time(P>0.05).There was no significant difference in the excellent and good rate between the two groups after 3 and 36 months of treatment(P>0.05).There was no recurrence of the lesion in both groups.The intertransverse process bone graft healed and the screw-rod system was well fixed.Conclusion:One-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation for treatment of Brucella spondylitis of lumbar spine are effective,with short operation time and less trauma,which are worthy of clinical promotion.展开更多
目的:探讨应用枕骨螺钉-棒-多轴螺钉内固定系统行枕颈固定融合术治疗“三明治”畸形伴寰枢关节脱位的临床效果。方法:回顾性分析2017年1月~2023年1月于我院因“三明治”畸形伴寰枢关节脱位行后路复位、植骨融合、枕颈内固定术的62例患者...目的:探讨应用枕骨螺钉-棒-多轴螺钉内固定系统行枕颈固定融合术治疗“三明治”畸形伴寰枢关节脱位的临床效果。方法:回顾性分析2017年1月~2023年1月于我院因“三明治”畸形伴寰枢关节脱位行后路复位、植骨融合、枕颈内固定术的62例患者,其中男性19例,女性43例,年龄51.1±23.5岁(29~72岁)。根据内固定系统枕骨端螺钉固定方式不同将患者分为两组:A组(38例)采用枕骨螺钉-棒-多轴螺钉内固定系统,男12例,女26例,年龄50.9±24.8岁(29~72岁),影像学表现脑干或颈髓受压30例、脊髓空洞6例、Chiari畸形2例;B组(24例)采用枕骨板-棒-多轴螺钉内固定系统,男7例,女17例,年龄51.4±22.4岁(32~69岁),影像学表现脑干或颈髓受压16例,脊髓空洞6例,Chiari畸形2例。A组随访时间36.5±11.8个月,B组随访时间36.1±9.8个月。两组患者年龄、性别、随访时间、影像表现无统计学差异(P>0.05)。收集并比较两组的术中出血量、手术时间、并发症发生率。术前及末次随访时进行颈部疼痛视觉模拟量表(visual analog scale,VAS)评分、颈椎功能障碍指数(neck disability index,NDI)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分,术后1周及末次随访时测量两组患者CT植骨融合部横断面及矢状面骨性融合面积,术前、术后1周及末次随访时测量两组患者寰齿前间隙(atlantodental interval,ADI)、脊髓可用空间(space available for cord,SAC)、斜坡-椎管角(clivus canal angle,CCA)、延髓-脊髓角(cervico-medullary angle,CMA)。结果:A组术中出血量362.4±89.1mL、手术时间144.8±35.6min,B组术中出血量345.1±93.7mL、手术时间143.7±36.2min,两组间无统计学差异(P>0.05)。随访期间两组均无脊髓损伤、脑脊液漏等严重并发症发生,B组有2例患者出现连接棒断裂,3例患者出现复位丢失。两组术前NDI、VAS评分、JOA评分与末次随访比较有显著性差异(P<0.05),两组同时间点比较均无统计学差异(P>0.05)。两组术前ADI、SAC、CCA、CMA与术后1周及末次随访比较有显著性差异(P<0.05),两组同时间点比较均无统计学差异(P>0.05)。A组术后1周植骨融合部横断面面积、植骨融合部矢状面面积分别为385.44±84.51mm^(2)、290.28±110.41mm^(2),末次随访时分别为267.06±66.13mm^(2)、204.54±83.85mm^(2);B组术后1周分别为442.61±76.85mm^(2)、267.21±104.63mm^(2),末次随访时分别为172.43±37.37mm^(2)、124.87±48.10mm^(2),两组术后1周植骨融合部横断面面积和植骨融合部矢状面面积比较无统计学差异(P>0.05),末次随访时有显著性差异(P<0.05)。结论:应用枕骨螺钉-棒-多轴螺钉内固定系统枕颈固定融合术治疗“三明治”畸形伴寰枢关节脱位同枕骨板-多轴螺钉内固定系统相比疗效相当,但术后植骨融合效果更好,能达到可靠的枕颈固定。展开更多
基金2018 Hebei health technology research and achievement transformation key project(No.zh2018014)2018 Hebei Medical applicable technology tracking project(No.gl2018074)+1 种基金2017 Zhangjiakou city level plan(No.17120010d)2018 Hebei North University School level scientific research project(No.yb2018010)
文摘Objective:To investigate the short-term and medium-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of Brucella spondylitis of the lumbar spine.Method:156 cases of Brucella spondylitis of lumbar spine were selected and divided into experimental group(n=80)and combined group(n=76)according to different surgical methods.The experimental group was treated with one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation.The combined group was treated with one-stage anterior debridement and intertransverse process bone grafting combined with posterior internal fixation.The operative indexes and clinical effects were compared between the two groups.Result:The operation time,intraoperative bleeding volume and time of landing after operation in the experimental group were less than those in the combined group,with statistical significance(P<0.05).VAS score,ODI index,Cobb angle and Frankel grade of nervous function in the two groups were significantly improved after 3 months and 36 months of treatment(P<0.05),but there was no significant difference between the two groups at the same time(P>0.05).There was no significant difference in the excellent and good rate between the two groups after 3 and 36 months of treatment(P>0.05).There was no recurrence of the lesion in both groups.The intertransverse process bone graft healed and the screw-rod system was well fixed.Conclusion:One-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation for treatment of Brucella spondylitis of lumbar spine are effective,with short operation time and less trauma,which are worthy of clinical promotion.
文摘目的:探讨应用枕骨螺钉-棒-多轴螺钉内固定系统行枕颈固定融合术治疗“三明治”畸形伴寰枢关节脱位的临床效果。方法:回顾性分析2017年1月~2023年1月于我院因“三明治”畸形伴寰枢关节脱位行后路复位、植骨融合、枕颈内固定术的62例患者,其中男性19例,女性43例,年龄51.1±23.5岁(29~72岁)。根据内固定系统枕骨端螺钉固定方式不同将患者分为两组:A组(38例)采用枕骨螺钉-棒-多轴螺钉内固定系统,男12例,女26例,年龄50.9±24.8岁(29~72岁),影像学表现脑干或颈髓受压30例、脊髓空洞6例、Chiari畸形2例;B组(24例)采用枕骨板-棒-多轴螺钉内固定系统,男7例,女17例,年龄51.4±22.4岁(32~69岁),影像学表现脑干或颈髓受压16例,脊髓空洞6例,Chiari畸形2例。A组随访时间36.5±11.8个月,B组随访时间36.1±9.8个月。两组患者年龄、性别、随访时间、影像表现无统计学差异(P>0.05)。收集并比较两组的术中出血量、手术时间、并发症发生率。术前及末次随访时进行颈部疼痛视觉模拟量表(visual analog scale,VAS)评分、颈椎功能障碍指数(neck disability index,NDI)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分,术后1周及末次随访时测量两组患者CT植骨融合部横断面及矢状面骨性融合面积,术前、术后1周及末次随访时测量两组患者寰齿前间隙(atlantodental interval,ADI)、脊髓可用空间(space available for cord,SAC)、斜坡-椎管角(clivus canal angle,CCA)、延髓-脊髓角(cervico-medullary angle,CMA)。结果:A组术中出血量362.4±89.1mL、手术时间144.8±35.6min,B组术中出血量345.1±93.7mL、手术时间143.7±36.2min,两组间无统计学差异(P>0.05)。随访期间两组均无脊髓损伤、脑脊液漏等严重并发症发生,B组有2例患者出现连接棒断裂,3例患者出现复位丢失。两组术前NDI、VAS评分、JOA评分与末次随访比较有显著性差异(P<0.05),两组同时间点比较均无统计学差异(P>0.05)。两组术前ADI、SAC、CCA、CMA与术后1周及末次随访比较有显著性差异(P<0.05),两组同时间点比较均无统计学差异(P>0.05)。A组术后1周植骨融合部横断面面积、植骨融合部矢状面面积分别为385.44±84.51mm^(2)、290.28±110.41mm^(2),末次随访时分别为267.06±66.13mm^(2)、204.54±83.85mm^(2);B组术后1周分别为442.61±76.85mm^(2)、267.21±104.63mm^(2),末次随访时分别为172.43±37.37mm^(2)、124.87±48.10mm^(2),两组术后1周植骨融合部横断面面积和植骨融合部矢状面面积比较无统计学差异(P>0.05),末次随访时有显著性差异(P<0.05)。结论:应用枕骨螺钉-棒-多轴螺钉内固定系统枕颈固定融合术治疗“三明治”畸形伴寰枢关节脱位同枕骨板-多轴螺钉内固定系统相比疗效相当,但术后植骨融合效果更好,能达到可靠的枕颈固定。
