腹膜后腹腔镜技术治疗腰椎椎间盘炎的疗效分析

目的探讨腹膜后腹腔镜技术治疗腰椎椎间盘炎的近期疗效及可行性。方法 2012年5月—2015年6月,本院采用腹膜后入路腹腔镜下单纯病灶清除及持续灌洗(无植骨内固定)治疗单节段腰椎椎间盘炎患者10例。记录手术时间、术中出血量、手术相关并发症及病原菌分离结果。随访12~24(19.8±4.9)个月。采用疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)以及影像学方法(包括X线、CT及MRI)评估疗效。结果手术时间(88.3±16.0)min,术中出血量(97.0±38.9)m L。病原菌培养结果显示真菌感染1例、表皮葡萄球菌感染3例、耐甲氧西林金黄色葡萄球菌(MRSA)感染1例、混合细菌感染1例、阴性4例。随访期间腰痛VAS评分与ODI较术前均有明显改善,差异具有统计学意义(P0.05)。末次随访时,影像学检查显示病变椎间隙近乎消失,相邻椎体间骨桥形成,其中7例患者出现部分椎体间骨性融合。无感染复发及手术并发症发生。结论对于无明显腰椎不稳及畸形的单节段腰椎椎间盘炎患者,腹膜后腹腔镜技术近期疗效可靠。

Efficacy analysis of retroperitoneal laparoscopic surgery for lumbar discitis

Objective To investigate the short-term clinical efficacy and feasibility of laparoscopic retroperitoneal approach for lumbar discitis. Methods From May 2012 to June 2015, 10 patients with single-level lumbar discitis were treated by retroperitoneoscopic debridement and continuously closed irrigation(without autogenous bone graft and instrumentation). The operation time, intraoperative blood loss, isolation of the pathogen and procedure-related complications were recorded. The mean follow-up time was (19.8±4.9)months (range, 12-24 months). To evaluate the surgical outcome and recovery, visual analogue scale(VAS) for back pain and Oswestry disability index(ODI) were used. Imaging evaluation included roentgenograph, CT scan and MRI. Results The operation time was (88.3±16.0)min; the intraoperative blood loss was (97.0±38.9)mL; the results of pathogen culture included Candida pseudotropicalis, MRSA, and co-exist of Escherichia coli, Pseudomonas aeruginosa and Acinetobacter baumannii in 1 case respectively, Staphylococcus epidermidis in 3 cases, and negative in 4. The postoperative VAS scores and ODIs during follow-up were more significantly reduced compared with those of pre-operation(P< 0.05). At the final follow-up, imaging data showed nearly disappearing of the intervertebral space and appearance of circumferential bone bridging in all patients, and partially interbody bony fusion in 7 patients. No infection relapse and procedure-related complications happened during the follow-up. Conclusion Retroperitoneal laparoscopic surgery is suitable for single-level lumbar discitis without evident spinal instability and vertebral body collapse with kyphosis, and can obtain good and reliable short-term outcome.