后路与前后路手术治疗腰椎布病性脊椎炎的比较

发布时间：2018-04-05 18:59

本文选题：布鲁杆菌病　切入点：脊椎炎　出处：《中国矫形外科杂志》2017年17期

【摘要】：[目的]通过回顾性比较单纯后路与前后路联合手术疗效,探讨腰椎布病性脊椎炎术式的选择。[方法]回顾性分析2007年6月~2015年6月手术治疗获得完整随访的65例腰椎布鲁杆菌性脊椎炎患者的临床及影像学资料。依据骨破坏情况、脓肿位置、神经损害及影像学分型,35例采用单纯后路椎板减压病灶清除椎弓根钉固定横突间植骨融合(单纯组),31例行前路病灶清除,同期联合后路椎弓根钉固定植骨术(联合组)。比较两组在手术时间、术中出血量、疼痛视觉模拟VAS评分、Oswestry功能障碍指数(Oswestry disability index)、ESC、影像学评价、脊柱后凸角(Cobb角)及ASIA评分改善的差异。[结果]两组手术时间、术中出血量、住院时间、ESC、脊柱后凸角(Cobb角)比较差异无统计学意义;影像学评价、VAS评分、ODI评分、ASIA评分比较术后1周差异有统计学意义,术后6个月差异无统计学意义。[结论]两种术式均能有效清除病灶,维持或重建脊柱稳定,有利于感染控制。单纯后路手术对于椎管内肉芽及脓肿清除效果较好,更适合中后柱病变特别是椎管内神经损害者;而前后路联合手术更适合存在椎体周围脓肿及腰大肌脓肿或前柱破坏较大病例。临床中应依据个性化治疗原则,根据感染浸润情况采取不同手术方式。
[Abstract]:[objective] to explore the choice of surgical methods for lumbar spondylitis by comparing the curative effect of posterior approach and anterior approach.[methods] the clinical and imaging data of 65 patients with brucellosis of lumbar vertebrae were analyzed retrospectively from June 2007 to June 2015.According to the condition of bone destruction, the location of abscess, nerve damage and imaging classification, 35 cases were treated with posterior lamina decompression.At the same time combined with posterior pedicle screw fixation bone graft (combined group).The time of operation, the amount of blood loss during operation, the VAS score of visual simulation of pain and the index of Oswestry disability were compared between the two groups. The imaging evaluation, the angle of kyphosis angle (Cobb angle) and the improvement of ASIA score were compared between the two groups.[results] there was no significant difference in operation time, intraoperative bleeding volume, hospitalization time and Cobb angle between the two groups, and there was significant difference in imaging evaluation of VAS score and ODI score and Asia score 1 week after operation.There was no significant difference 6 months after operation.[conclusion] both methods can effectively clear the lesions, maintain or reconstruct the stability of the spine, and be beneficial to the control of infection.Simple posterior approach for the removal of granulation and abscess in the spinal canal is better, more suitable for the lesions of the middle posterior column, especially the nerve damage in the spinal canal.Combined anterior and posterior approach is more suitable for patients with perivertebral abscess, abscess of psoas major muscle or large anterior column destruction.Different operative methods should be adopted according to the principle of individualized treatment and infection infiltration.
【作者单位】：河北北方学院附属第一医院脊柱关节外科;河北北方学院;
【基金】：2014年河北省医学重点学科跟踪项目(编号:GL2014069) 2016年河北省医学重点学科跟踪项目(编号:GL2016069) 2015年河北省政府资助临床医学优秀人才培养和基础课题研究项目(编号:361009)
【分类号】：R687.3

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