后路腰椎椎体间融合术治疗腰椎布鲁杆菌性脊柱炎的疗效分析

目的 探讨后路腰椎椎体间融合(PLIF)手术治疗腰椎单节段布鲁杆菌性脊柱炎的手术疗效。方法 收集新疆维吾尔自治区胸科医院2010年1月至2015年1月收治并采用PLIF手术治疗的单运动节段受累的腰椎布鲁杆菌性脊柱炎67例患者的临床资料。其中,男49例,女18例;平均年龄(49.9±13.0)岁。患者术前Frankel分级E级24例、D级24例、C级1例。患者均在全麻下行经后路椎弓根螺钉固定、单侧椎板切除开窗病灶清除自体骨粒椎间植骨融合术。术后对患者进行随访,评估疼痛视觉模拟评分(visual analogue scale score,VAS)及Frankel分级;对患者进行血红细胞沉降率(ESR)、C-反应蛋白(CRP)、布鲁杆菌血清凝集试验、腰椎正侧位X线摄影及 CT扫描复查,评定术后植骨愈合情况。结果 67例患者术后病理证实均为布鲁杆菌感染。患者平均手术时间为(101±23)min,平均失血量为 (95.22±56.87)ml。术中未出现脊髓、神经及血管损伤;术后3~7d行腰椎正侧位X线摄影复查,显示内固定均无松动,植骨位置均良好;术后有3例患者出现脑脊液漏,经过2周相应的治疗后治愈。患者术后随访9~24个月,末次随访时未见内固定松动,未发生断钉、断棒。所有患者均未见复发,未见切口延迟愈合及窦道形成。术前及术后1、3、6、12个月VAS评分分别为(7.16±0.91)、(4.19±0.92)、(3.06±0.92)、(1.48±0.59)及0分;术后各时间点VAS评分均较术前有明显改善,差异有统计学意义(F=355.95,P<0.01)。术后6个月复查ESR和CRP均恢复正常;术后9个月时行布鲁杆菌血清凝集试验复查,均转为阴性。术后行腰椎正侧位X线摄影及CT扫描复查,显示患者植骨融合情况均良好,Bridwell骨愈合标准评定术后植骨愈合,均能达到Ⅰ级愈合。患者神经功能改善明显,1例患者Frankel分级由术前C级恢复至术后E级,24例患者由术前D级恢复至E级。结论 PLIF手术是治疗腰骶椎布鲁杆菌性脊柱炎安全、有效的方法。

Efficacy analysis of posterior lumbar interbody fusion for lumbar Brucellar spondylitis

Objective To investigate the surgical efficacy of posterior lumbar interbody fusion (PLIF) in treating lumbar Brucellar spondylitis patients with single-segment involvement.Methods The clinical data were collected from 67 lumbar Brucellar spondylitis patients with single-segment involvement who received PLIF surgery in Xinjiang Uygur Autonomous Region Chest Hospital from January 2010 to January 2015. Among them, 49 patients were male, and 18 were female. The mean age was (49.9±13.0) years. There were 24 cases with Frankel Grade E, 24 with Grade D, and one with Grade C before the surgery. Under general anesthesia, all patients underwent posterior pedicle screw fixation, unilateral laminectomy and fenestration, debridement, and autologous bone interbody fusion. Patients were followed up postoperative. The visual analogue scale score (VAS) and Frankel classi-fication were evaluated, rythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured, and Brucella serum agglutination test was conducted. Also, frontal and lateral X-ray and CT scan were performed to assess the extent of postoperative bone graft healing.Results All of the 67 patients were confirmed Brucella infection by postoperative pathology. The mean operation time was (101±23) minutes and the mean blood loss was (95.22±56.87) ml. No spinal cord, nerve and blood vessel injury occurred during operation. Three to 7 days after surgery, frontal and lateral X-ray results showed no loosening of the internal fixation and good position of the bone graft. Three patients experienced (cerebrospinal fluid) CSF leakage after operation, but all were cured after 2 weeks of treatment. The patients were followed up for 9 to 24 months. At the last follow-up, no internal fixation was loosened, and no nail or rod was broken. No patient recurred. There was no delayed healing and sinus formation. The VAS score was (7.16±0.91) before surgery, and (4.19±0.92), (3.06±0.92), (1.48±0.59) and 0 at 1-, 3-, 6- and 12-month time-point after surgery; significant improvement in VAS score was observed after operation at different time points (F=355.95, P<0.01). The ESR and CRP levels became normal 6 months later after operation. The result of Brucella serum agglutination test 9 months postoperatively indicated that all patients became negative. Frontal and lateral X-ray and CT scan showed that all patients achieved good bone graft fusion. According to the Bridwell criteria for postoperative graft bone healing, all patients achieved Grade I. The neurological function was significantly improved: the Frankel’s Grade was restored from Grade C to E in one patient and from Grade D to E in 24 patients.Conclusion PLIF is a safe and effective method in treating lumbar Brucellar spondylitis.