一期后路肌间隙入路病灶清除、植骨内固定术治疗腰椎椎间隙感染的临床研究

发布时间：2018-09-06 15:10

【摘要】：目的：评价一期后路经双侧椎旁肌间隙入路行病灶清除植骨内固定术治疗腰椎椎间隙感染的效果。方法：纳入2012年10月至2014年5月我科收治的82例腰椎椎间隙感染患者,其中化脓性腰椎椎间隙感染患者14例,布氏杆菌性腰椎椎间隙感染患者11例,不明原因性腰椎椎间隙感染患者17例,结核性腰椎椎间隙感染患者40例。男47例女35例,年龄19-72岁,平均46岁。其中L2-L35例,L3-L412例,L4-L536例,L5-S129例。所有患者均采用一期经后正中切口双侧椎旁肌间隙入路手术方式行病灶清除、自体骨植骨融合及椎弓根内固定治疗。影像学评价为椎体融合情况；临床疗效评价：视觉模拟评分法(VAS)、JOA腰椎功能评分。结果：82例患者术后症状均有明显缓解,VAS评分：化脓组术前8.78±0.97分,术后一周2.36±0.84分,末次随访1.00±0.68分；布氏杆菌病组术前7.55±0.82分,术后一周2.55±0.69分,末次随访1.09±0.54分；不明原因组术前8.12±0.93分,术后一周2.47±0.62分,末次随访0.88±0.60分；结核组术前7.25±0.71分,术后一周2.85±0.98分,末次随访1.50±0.93分,所有患者VAS评分术后较术前明显降低,差异有统计学意义(P0.05)。JOA腰椎功能评分：所有手术患者术后评价为显效,其中改善率为优68.29%,良24.39%,中7.32%,优良率92.68%。所有患者共随访8-18个月(平均13个月),其中2例患者术后切口窦道形成,经再次清创后痊愈；2例患者术后症状复发,再次行手术治疗后痊愈。所有患者末次随访x线复查未见内固定松动,75例患者达到影像学上的植骨融合,7例患者未达到融合标准,但无任何临床症状及体征。结论：经后正中切口双侧椎旁肌间隙入路一期行椎间隙感染病灶清除、植骨内固定术对于腰椎椎间隙感染的患者提供了一种良好的治疗方法,可以彻底清除病灶,并提供坚强的内固定,临床疗效满意。
[Abstract]:Objective: To evaluate the effect of one-stage posterior approach via bilateral paravertebral muscular space on the treatment of lumbar intervertebral infection. Methods: 82 patients with lumbar intervertebral infection, including 14 patients with purulent lumbar intervertebral space infection, 14 patients with Brucella lumbar intervertebral space infection, were enrolled in our department from October 2012 to May 2014. There were 11 cases of infection, 17 cases of unidentified lumbar intervertebral infection and 40 cases of tuberculous lumbar intervertebral infection. There were 47 males and 35 females, aged 19-72 years, with an average age of 46 years. Results: All the 82 patients were relieved obviously, and the VAS score was 8.78 [0.97] before operation, 2.36 [0.84] a week after operation, and 1.00 [0.68] at the last follow-up. Brucellosis group: 7.55 + 0.82 points before operation, 2.55 + 0.69 points a week after operation, 1.09 + 0.54 points at the last follow-up; 8.12 + 0.93 points before operation, 2.47 + 0.62 points a week after operation, 0.88 + 0.60 points at the last follow-up; tuberculosis group: 7.25 + 0.71 points before operation, 2.85 + 0.98 points a week after operation, 1.50 + 0.93 points at the last follow-up JOA lumbar spinal function score: all patients were evaluated as effective, including 68.29% excellent, 24.39% good, 7.32% good and 92.68% good. All patients were followed up for 8-18 months (average 13 months). Two of them were cured after debridement. All patients had no loosening of internal fixation at the last follow-up X-ray, 75 had achieved bone graft fusion on imaging, 7 had not reached the fusion standard, but had no clinical symptoms and signs. Removal of infected lesions, bone grafting and internal fixation provide a good treatment for patients with lumbar intervertebral infection, can thoroughly remove the lesions, and provide a strong internal fixation, clinical efficacy is satisfactory.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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