前路手术治疗颈椎布鲁氏杆菌脊柱炎临床研究
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摘要
目的探讨临床较为罕见的颈椎布鲁氏杆菌性脊柱炎行前路手术的治疗效果。方法回顾性分析2005年2月～2017年12月本院诊治的19例颈椎布鲁氏杆菌性脊柱炎患者临床资料,患者术前均行X线片、 MRI检查,均接受前路病灶清除椎间植骨内固定术治疗,分析患者一般情况、治疗疗效、视觉模拟疼痛评分(visual analogue score, VAS)、日本骨科学会评分(Japanese Orthopaedic Association, JOA)及近期随访情况。结果 19例患者平均手术时间(52.52±10.62)min,术中出血量(282.01±8.32)ml,术中未见脊髓、神经及血管损伤,无食管气管瘘等并发症发生,术后切口均Ⅰ期愈合;术后3、6、12个月总有效率分别为89.47%、94.74%,100%,三者相较无明显差异(χ~2=2.111,P>0.05);与术前相较,术后12个月患者VAS评分明显降低,JOA评分明显升高(P<0.001);术后3～6个月随访发现患者植骨融合、病灶修复良好,颈椎稳定,术后7～12个月随访未发现颈椎滑脱、椎间植骨和内固定失败,脓肿及死骨等并发症。结论前路病灶清除Cage或钛笼植骨融合固定手术应用于颈椎布鲁氏杆菌性脊柱炎患者,可有效控制病变发展,缓解局部疼痛,重建颈椎稳定性,促进颈椎功能恢复,改善预后,且安全性好。
Objective To investigate the curative effect of anterior approach for Brucella spondylitis in cervical vertebrae. Methods The clinical data of 19 patients with Brucella spondylitis in cervical vertebrae who were diagnosed and treated in our hospital from February 2005 to December 2017 were retrospectively analyzed. All patients underwent X-ray and MRI before operation. All patients underwent internal fixation with anterior radical debridement and interbody fusion. The surgical general condition,curative effect of treatment,visual analogue score( VAS),scores of Japanese Orthopaedic Association( JOA) and recent follow-up of all the 19 patients were analyzed. Results In the 19 patients,average operation time and intraoperative blood loss was( 52. 52 ± 10. 62) min and( 282. 01 ± 8.32) ml respectively. There was no spinal cord,nerve and vascular injury,nor esophagotracheal fistula during the surgery. Postoperative incision was healed at stage I. The total response rate at 3,6,and 12 months after surgery were 89.47%,94.74%,and 100% respectively( χ~2= 2.111,P> 0.05). The VAS scores significantly decreased, while the JOA scores significantly increased after surgery( P < 0. 001).It was found of the fair fusion of the bone graft,good lesions repair,and stable cervical vertebrae within 3 to 6 months follow-up. There was no cervical spondylolisthesis,failure of intervertebral bone grafting or internal fixation,abscess or dead bone during the 7 to 12 months follow-up. Conclusion The application of anterior approach with debridement and titanium mesh cage graft internal fixtion can effectively control the development of lesions,relieve pain,reconstruct cervical stability,promote function recovery,and improve prognosis with good safety for patients with Brucella spondylitis in cervical vertebrae.
Objective To investigate the curative effect of anterior approach for Brucella spondylitis in cervical vertebrae. Methods The clinical data of 19 patients with Brucella spondylitis in cervical vertebrae who were diagnosed and treated in our hospital from February 2005 to December 2017 were retrospectively analyzed. All patients underwent X-ray and MRI before operation. All patients underwent internal fixation with anterior radical debridement and interbody fusion. The surgical general condition,curative effect of treatment,visual analogue score( VAS),scores of Japanese Orthopaedic Association( JOA) and recent follow-up of all the 19 patients were analyzed. Results In the 19 patients,average operation time and intraoperative blood loss was( 52. 52 ± 10. 62) min and( 282. 01 ± 8.32) ml respectively. There was no spinal cord,nerve and vascular injury,nor esophagotracheal fistula during the surgery. Postoperative incision was healed at stage I. The total response rate at 3,6,and 12 months after surgery were 89.47%,94.74%,and 100% respectively( χ~2= 2.111,P> 0.05). The VAS scores significantly decreased, while the JOA scores significantly increased after surgery( P < 0. 001).It was found of the fair fusion of the bone graft,good lesions repair,and stable cervical vertebrae within 3 to 6 months follow-up. There was no cervical spondylolisthesis,failure of intervertebral bone grafting or internal fixation,abscess or dead bone during the 7 to 12 months follow-up. Conclusion The application of anterior approach with debridement and titanium mesh cage graft internal fixtion can effectively control the development of lesions,relieve pain,reconstruct cervical stability,promote function recovery,and improve prognosis with good safety for patients with Brucella spondylitis in cervical vertebrae.
引文
[1] 罗成,齐江矫,王元元,等.利用重叠延伸PCR构建红色荧光蛋白布鲁氏菌表达载体[J].中国畜牧兽医,2018,45(9):2394-2400.
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[11] 蓝旭,高杰,许建中,等.布氏杆菌性脊柱炎的影像学分型与治疗方案选择[J].中国骨与关节损伤杂志,2017,32(1):40-43.
[12] 费正奇,韩敬凛,陈波,等.颈椎布鲁杆菌性脊柱炎的临床特点和外科手术治疗[J].临床和实验医学杂志,2018,28(2):183-185.
[13] 杨成伟,蓝旭,李松凯,等.颈椎布鲁杆菌性脊柱炎合并硬膜外脓肿的手术治疗[J].脊柱外科杂志,2017,15(5):257-261.
[14] 章鹏.一期前路手术治疗颈椎布鲁杆菌性脊柱炎的相关研究[D].河北北方学院,2015.1-43.
[15] 杨应川,张作秀,吴琴.三阶段攻坚奠定牛羊布鲁氏杆菌病控制基础[J].饲料工业,2016,37(15):54-56.
[16] 何剑南,姚猛.布氏杆菌性脊柱炎的诊断及治疗进展[J].颈腰痛杂志,2016,37(2):147-149.
[17] 杨新明,石蔚,杜雅坤,等.布氏杆菌性脊柱炎临床影像学表现及外科治疗[J].中国矫形外科杂志,2007,15(19):1463-1466.
[2] 张胜,孟萌,王晓慧,等.颈椎布鲁氏杆菌病性脊柱炎1例及相关文献复习[J].风湿病与关节炎,2018,7(5):45-47.
[3] Lee HJ,Hur JW,Lee JW,et al.Brucellar spondylitis[J].J Korean Neurosurg Soc,2008,44(4):277-279.
[4] 赵疆,涂来勇,刘振峰,等.布鲁氏杆菌病性脊柱炎影像学诊断及表现特点[J].骨科,2017,8(6):445-450.
[5] 杨新明,张磊,刘肃,等.脊柱疾病[M].北京:科学技术文献出版社,2011:271-275.
[6] 贺永雄,东家茂,刘斌,等.颈椎布鲁杆菌病性脊椎炎的早期诊断与治疗[J].脊柱外科杂志,2013,11(2):92-96.
[7] 闫斌,杨新明,孟宪勇,等.布鲁氏杆菌病性脊柱炎的诊断及外科综合治疗[J].实用骨科杂志,2015,35(9):774-779.
[8] 杨保辉,李浩鹏,卢腾,等.布鲁氏杆菌性脊柱炎的诊断和治疗[J].实用骨科杂志,2016,22(12):1115-1118.
[9] 段力军,武永刚,阿尔宾,等.布氏菌性脊柱炎的微创手术治疗[J].中华骨与关节外科杂志,2015,36(1):78-80.
[10] 杨卫良,徐佳元.36例布鲁氏杆菌性脊柱炎的诊断及手术治疗[J].中国矫形外科杂志,2011,19(17):1438-1441.
[11] 蓝旭,高杰,许建中,等.布氏杆菌性脊柱炎的影像学分型与治疗方案选择[J].中国骨与关节损伤杂志,2017,32(1):40-43.
[12] 费正奇,韩敬凛,陈波,等.颈椎布鲁杆菌性脊柱炎的临床特点和外科手术治疗[J].临床和实验医学杂志,2018,28(2):183-185.
[13] 杨成伟,蓝旭,李松凯,等.颈椎布鲁杆菌性脊柱炎合并硬膜外脓肿的手术治疗[J].脊柱外科杂志,2017,15(5):257-261.
[14] 章鹏.一期前路手术治疗颈椎布鲁杆菌性脊柱炎的相关研究[D].河北北方学院,2015.1-43.
[15] 杨应川,张作秀,吴琴.三阶段攻坚奠定牛羊布鲁氏杆菌病控制基础[J].饲料工业,2016,37(15):54-56.
[16] 何剑南,姚猛.布氏杆菌性脊柱炎的诊断及治疗进展[J].颈腰痛杂志,2016,37(2):147-149.
[17] 杨新明,石蔚,杜雅坤,等.布氏杆菌性脊柱炎临床影像学表现及外科治疗[J].中国矫形外科杂志,2007,15(19):1463-1466.