腰椎布鲁杆菌脊柱炎影像学分期及经椎间孔病灶清除融合术疗效分析

发布时间：2018-01-03 05:27

本文关键词：腰椎布鲁杆菌脊柱炎影像学分期及经椎间孔病灶清除融合术疗效分析　出处：《南方医科大学》2017年博士论文　论文类型：学位论文

【摘要】：目的本研究分析腰椎布鲁杆菌脊柱炎不同病期的影像学特点,探讨腰椎布鲁杆菌脊柱炎影像学分期,以提高对该疾病的诊断水平。探讨腰椎经椎间孔病灶清除融合术(TLIDF)治疗腰椎布鲁杆菌脊柱炎的可行性及临床疗效。方法本研究收集2010年2月至2013年6月我院22例手术治疗的腰椎布鲁杆菌脊柱炎患者,术前均行腰椎X线、CT扫描及MRI检查,观察影像学的不同表现,并对其进行分期。22例TLIDF术治疗的腰椎布鲁杆菌脊柱炎患者,术前至少经过3周正规药物治疗,术后继续规范使用抗布病药物6月。临床评价内容包括:术后有无并发症、复发情况,记录围手术期及随访期间ESR、CRP化验指标,记录手术前后的疼痛视觉模拟(VAS)评分及ODI评分等指标来评价临床疗效。采用SPSS19.0统计软件对数据进行统计分析。结果腰椎布鲁杆菌脊柱炎影像学分为三期:①早期:X线片、CT片基本正常,MRI示椎体及椎旁异常炎性信号;②中期:X线片示受累节段椎间隙高度正常或变窄,CT片示椎间终板有小溶骨破坏灶及增生硬化,MRI示椎间、椎体炎性信号,椎管内、椎旁局限性脓肿;③晚期:X线片受累椎间隙变窄,椎间终板显示欠清,椎体周缘可见骨赘增生,CT片示椎体增生硬化,炎性骨赘增生与溶骨破坏并存,椎体周缘呈花边样外观,MRI示椎间、椎体炎性信号,椎管内、椎旁脓肿较为广泛,形成腰大肌内脓肿。依据影像学表现制定手术方案,20例选择后路感染病灶清除+TLIF术(TLIDF术),1例选择TLIDF+前路腰大肌脓肿清除术,1例行腰椎布病TLIDF翻修术。术后伤口均一期愈合,无局部窦道形成,无脊髓、马尾或神经根损伤发生,随访期间腰椎布病感染无复发。术前1周红细胞沉降率(ESR)为37.7±25.4 mm/h,C-反应蛋白(CRP)为 33.1±29.3mg/L。术后 1 周 ESR 为 48.7±26.4mm/h,CRP 为51.5±44.1mg/L,较术前增高(p0.05)。术后 3 个月 ESR 为 11.4±6.3mm/h,CRP为9.6±7.4mg/L,与术前和术后1周相比ESR与CRP水平显著降低(p0.05)。手术后VAS评分显著低于手术前(2.66±1.04 vs.6.82±2.14,p0.05)。术后与手术前相比,ODI评分显著降低(8.82±1.73 vs.35.72±1.91,p0.05)。结论腰椎布病不同病期在影像学上有其各自特征性表现,归类后可分为早期、中期和晚期。腰椎布病可累及单节段与多节段,受累节段可呈跳跃性,多节段感染在影像学上可呈不同分期并存的特征。在药物治疗的基础上,TLIDF可有效清除病灶、重建脊柱的稳定性:腰椎布鲁杆菌脊柱炎TLIDF术后腰痛及下肢神经症状即刻缓解,术后无复发病例,远期临床疗效确切。
[Abstract]:Objective to analyze the imaging features of different stages of spondylitis of Brucella lumbar vertebrae and to discuss the imaging stages of spondylitis of brucellosis. To improve the diagnostic level of the disease. To discuss the lumbar transforaminal focal debridement and fusion (TLIDF). Methods from February 2010 to June 2013, 22 cases of lumbar brucellae spondylitis treated surgically in our hospital were collected. X-ray CT and MRI were performed before operation to observe the different imaging manifestations, and 22 cases of lumbar brucellae spondylitis were treated by TLIDF. After at least 3 weeks of regular drug treatment before the operation, continue to standardize the use of anti-brucellosis drugs June. Clinical evaluation included: postoperative complications, recurrence, perioperative and follow-up records of ESR. CRP assay index. Recording of visual analogue pain before and after surgery. The data were analyzed by SPSS19.0 software. Results the imaging images of brucellae spondylitis were divided into three stages: early stage 1: X ray film. MRI showed abnormal inflammatory signals in vertebrae and paravertebral vertebrae. (2) in the middle stage, the intervertebral space was normal or narrowed in the middle stage. Ct showed that the intervertebral end plate had small osteolytic lesion and hyperplastic sclerosis. MRI showed intervertebral inflammatory signal, localized abscess in the spinal canal and paravertebral region. (3) in the late stage, the intervertebral space was narrowed, the intervertebral endplate was not clear, the osteophyte hyperplasia was seen around the vertebral body and CT film showed that the inflammatory osteophyte hyperplasia and osteolysis existed side by side. MRI showed intervertebral, inflammatory signal in vertebral canal and paravertebral abscess, which resulted in intramuscular abscess of psoas. 20 cases were treated with posterior approach TLIF debridement and 1 case with TLIDF anterior psoas major abscess removal. One patient underwent TLIDF revision of lumbar spondylopathy. The wound healed at the first stage, no local sinus formation, no injury of spinal cord, cauda equina or nerve root. During the follow-up period, there was no recurrence of infection in the lumbar vertebrae, the erythrocyte sedimentation rate and erythrocyte sedimentation rate were 37.7 卤25.4 mm/h before operation. The CRP was 33.1 卤29.3 mg / L and the ESR was 48.7 卤26.4mm / h at 1 week postoperatively. The CRP was 51.5 卤44.1 mg / L, which was higher than that before operation (p 0.05), and the ESR was 11.4 卤6.3 mm / h 3 months after operation. CRP was 9.6 卤7.4 mg / L. Compared with preoperative and postoperative 1 week, the levels of ESR and CRP decreased significantly (P 0.05). The VAS score after operation was significantly lower than that before operation (2.66 卤1.04 vs.6.82 卤2.14). Compared with before operation, the score of postoperative ODI decreased significantly (8.82 卤1.73 vs.35.72 卤1.91). Conclusion different stages of lumbar spondylosis have their own imaging features, which can be classified into early, middle and late stages. Lumbar spondylosis can involve single and multiple segments. The involved segment may be leaping and the multi-segment infection may coexist in different stages on imaging. TLIDF can effectively clear the lesions on the basis of drug therapy. Reconstruction of spinal stability: lumbar brucellae spondylitis after TLIDF lumbago and lower extremity neurological symptoms immediately relieved, no recurrence cases, long-term clinical effect is accurate.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R687.3

【相似文献】