本文關(guān)鍵詞：腰椎布魯桿菌脊柱炎影像學(xué)分期及經(jīng)椎間孔病灶清除融合術(shù)療效分析　出處：《南方醫(yī)科大學(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 布魯桿菌脊柱炎 腰椎 影像學(xué)分期 TLIDF

【摘要】：目的本研究分析腰椎布魯桿菌脊柱炎不同病期的影像學(xué)特點,探討腰椎布魯桿菌脊柱炎影像學(xué)分期,以提高對該疾病的診斷水平。探討腰椎經(jīng)椎間孔病灶清除融合術(shù)(TLIDF)治療腰椎布魯桿菌脊柱炎的可行性及臨床療效。方法本研究收集2010年2月至2013年6月我院22例手術(shù)治療的腰椎布魯桿菌脊柱炎患者,術(shù)前均行腰椎X線、CT掃描及MRI檢查,觀察影像學(xué)的不同表現(xiàn),并對其進行分期。22例TLIDF術(shù)治療的腰椎布魯桿菌脊柱炎患者,術(shù)前至少經(jīng)過3周正規(guī)藥物治療,術(shù)后繼續(xù)規(guī)范使用抗布病藥物6月。臨床評價內(nèi)容包括:術(shù)后有無并發(fā)癥、復(fù)發(fā)情況,記錄圍手術(shù)期及隨訪期間ESR、CRP化驗指標,記錄手術(shù)前后的疼痛視覺模擬(VAS)評分及ODI評分等指標來評價臨床療效。采用SPSS19.0統(tǒng)計軟件對數(shù)據(jù)進行統(tǒng)計分析。結(jié)果腰椎布魯桿菌脊柱炎影像學(xué)分為三期:①早期:X線片、CT片基本正常,MRI示椎體及椎旁異常炎性信號;②中期:X線片示受累節(jié)段椎間隙高度正�；蜃冋�,CT片示椎間終板有小溶骨破壞灶及增生硬化,MRI示椎間、椎體炎性信號,椎管內(nèi)、椎旁局限性膿腫;③晚期:X線片受累椎間隙變窄,椎間終板顯示欠清,椎體周緣可見骨贅增生,CT片示椎體增生硬化,炎性骨贅增生與溶骨破壞并存,椎體周緣呈花邊樣外觀,MRI示椎間、椎體炎性信號,椎管內(nèi)、椎旁膿腫較為廣泛,形成腰大肌內(nèi)膿腫。依據(jù)影像學(xué)表現(xiàn)制定手術(shù)方案,20例選擇后路感染病灶清除+TLIF術(shù)(TLIDF術(shù)),1例選擇TLIDF+前路腰大肌膿腫清除術(shù),1例行腰椎布病TLIDF翻修術(shù)。術(shù)后傷口均一期愈合,無局部竇道形成,無脊髓、馬尾或神經(jīng)根損傷發(fā)生,隨訪期間腰椎布病感染無復(fù)發(fā)。術(shù)前1周紅細胞沉降率(ESR)為37.7±25.4 mm/h,C-反應(yīng)蛋白(CRP)為 33.1±29.3mg/L。術(shù)后 1 周 ESR 為 48.7±26.4mm/h,CRP 為51.5±44.1mg/L,較術(shù)前增高(p0.05)。術(shù)后 3 個月 ESR 為 11.4±6.3mm/h,CRP為9.6±7.4mg/L,與術(shù)前和術(shù)后1周相比ESR與CRP水平顯著降低(p0.05)。手術(shù)后VAS評分顯著低于手術(shù)前(2.66±1.04 vs.6.82±2.14,p0.05)。術(shù)后與手術(shù)前相比,ODI評分顯著降低(8.82±1.73 vs.35.72±1.91,p0.05)。結(jié)論腰椎布病不同病期在影像學(xué)上有其各自特征性表現(xiàn),歸類后可分為早期、中期和晚期。腰椎布病可累及單節(jié)段與多節(jié)段,受累節(jié)段可呈跳躍性,多節(jié)段感染在影像學(xué)上可呈不同分期并存的特征。在藥物治療的基礎(chǔ)上,TLIDF可有效清除病灶、重建脊柱的穩(wěn)定性:腰椎布魯桿菌脊柱炎TLIDF術(shù)后腰痛及下肢神經(jīng)癥狀即刻緩解,術(shù)后無復(fù)發(fā)病例,遠期臨床療效確切。
[Abstract]:Objective to analyze the imaging features of different stages of spondylitis of Brucella lumbar vertebrae and to discuss the imaging stages of spondylitis of brucellosis. To improve the diagnostic level of the disease. To discuss the lumbar transforaminal focal debridement and fusion (TLIDF). Methods from February 2010 to June 2013, 22 cases of lumbar brucellae spondylitis treated surgically in our hospital were collected. X-ray CT and MRI were performed before operation to observe the different imaging manifestations, and 22 cases of lumbar brucellae spondylitis were treated by TLIDF. After at least 3 weeks of regular drug treatment before the operation, continue to standardize the use of anti-brucellosis drugs June. Clinical evaluation included: postoperative complications, recurrence, perioperative and follow-up records of ESR. CRP assay index. Recording of visual analogue pain before and after surgery. The data were analyzed by SPSS19.0 software. Results the imaging images of brucellae spondylitis were divided into three stages: early stage 1: X ray film. MRI showed abnormal inflammatory signals in vertebrae and paravertebral vertebrae. (2) in the middle stage, the intervertebral space was normal or narrowed in the middle stage. Ct showed that the intervertebral end plate had small osteolytic lesion and hyperplastic sclerosis. MRI showed intervertebral inflammatory signal, localized abscess in the spinal canal and paravertebral region. (3) in the late stage, the intervertebral space was narrowed, the intervertebral endplate was not clear, the osteophyte hyperplasia was seen around the vertebral body and CT film showed that the inflammatory osteophyte hyperplasia and osteolysis existed side by side. MRI showed intervertebral, inflammatory signal in vertebral canal and paravertebral abscess, which resulted in intramuscular abscess of psoas. 20 cases were treated with posterior approach TLIF debridement and 1 case with TLIDF anterior psoas major abscess removal. One patient underwent TLIDF revision of lumbar spondylopathy. The wound healed at the first stage, no local sinus formation, no injury of spinal cord, cauda equina or nerve root. During the follow-up period, there was no recurrence of infection in the lumbar vertebrae, the erythrocyte sedimentation rate and erythrocyte sedimentation rate were 37.7 鹵25.4 mm/h before operation. The CRP was 33.1 鹵29.3 mg / L and the ESR was 48.7 鹵26.4mm / h at 1 week postoperatively. The CRP was 51.5 鹵44.1 mg / L, which was higher than that before operation (p 0.05), and the ESR was 11.4 鹵6.3 mm / h 3 months after operation. CRP was 9.6 鹵7.4 mg / L. Compared with preoperative and postoperative 1 week, the levels of ESR and CRP decreased significantly (P 0.05). The VAS score after operation was significantly lower than that before operation (2.66 鹵1.04 vs.6.82 鹵2.14). Compared with before operation, the score of postoperative ODI decreased significantly (8.82 鹵1.73 vs.35.72 鹵1.91). Conclusion different stages of lumbar spondylosis have their own imaging features, which can be classified into early, middle and late stages. Lumbar spondylosis can involve single and multiple segments. The involved segment may be leaping and the multi-segment infection may coexist in different stages on imaging. TLIDF can effectively clear the lesions on the basis of drug therapy. Reconstruction of spinal stability: lumbar brucellae spondylitis after TLIDF lumbago and lower extremity neurological symptoms immediately relieved, no recurrence cases, long-term clinical effect is accurate.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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