本文選題：布魯桿菌病　切入點：脊椎炎　出處：《中國矯形外科雜志》2017年17期

【摘要】：[目的]通過回顧性比較單純后路與前后路聯(lián)合手術療效,探討腰椎布病性脊椎炎術式的選擇。[方法]回顧性分析2007年6月~2015年6月手術治療獲得完整隨訪的65例腰椎布魯桿菌性脊椎炎患者的臨床及影像學資料。依據(jù)骨破壞情況、膿腫位置、神經(jīng)損害及影像學分型,35例采用單純后路椎板減壓病灶清除椎弓根釘固定橫突間植骨融合(單純組),31例行前路病灶清除,同期聯(lián)合后路椎弓根釘固定植骨術(聯(lián)合組)。比較兩組在手術時間、術中出血量、疼痛視覺模擬VAS評分、Oswestry功能障礙指數(shù)(Oswestry disability index)、ESC、影像學評價、脊柱后凸角(Cobb角)及ASIA評分改善的差異。[結果]兩組手術時間、術中出血量、住院時間、ESC、脊柱后凸角(Cobb角)比較差異無統(tǒng)計學意義;影像學評價、VAS評分、ODI評分、ASIA評分比較術后1周差異有統(tǒng)計學意義,術后6個月差異無統(tǒng)計學意義。[結論]兩種術式均能有效清除病灶,維持或重建脊柱穩(wěn)定,有利于感染控制。單純后路手術對于椎管內(nèi)肉芽及膿腫清除效果較好,更適合中后柱病變特別是椎管內(nèi)神經(jīng)損害者;而前后路聯(lián)合手術更適合存在椎體周圍膿腫及腰大肌膿腫或前柱破壞較大病例。臨床中應依據(jù)個性化治療原則,根據(jù)感染浸潤情況采取不同手術方式。
[Abstract]:[objective] to explore the choice of surgical methods for lumbar spondylitis by comparing the curative effect of posterior approach and anterior approach.[methods] the clinical and imaging data of 65 patients with brucellosis of lumbar vertebrae were analyzed retrospectively from June 2007 to June 2015.According to the condition of bone destruction, the location of abscess, nerve damage and imaging classification, 35 cases were treated with posterior lamina decompression.At the same time combined with posterior pedicle screw fixation bone graft (combined group).The time of operation, the amount of blood loss during operation, the VAS score of visual simulation of pain and the index of Oswestry disability were compared between the two groups. The imaging evaluation, the angle of kyphosis angle (Cobb angle) and the improvement of ASIA score were compared between the two groups.[results] there was no significant difference in operation time, intraoperative bleeding volume, hospitalization time and Cobb angle between the two groups, and there was significant difference in imaging evaluation of VAS score and ODI score and Asia score 1 week after operation.There was no significant difference 6 months after operation.[conclusion] both methods can effectively clear the lesions, maintain or reconstruct the stability of the spine, and be beneficial to the control of infection.Simple posterior approach for the removal of granulation and abscess in the spinal canal is better, more suitable for the lesions of the middle posterior column, especially the nerve damage in the spinal canal.Combined anterior and posterior approach is more suitable for patients with perivertebral abscess, abscess of psoas major muscle or large anterior column destruction.Different operative methods should be adopted according to the principle of individualized treatment and infection infiltration.
【作者單位】： 河北北方學院附屬第一醫(yī)院脊柱關節(jié)外科;河北北方學院;
【基金】：2014年河北省醫(yī)學重點學科跟蹤項目(編號:GL2014069) 2016年河北省醫(yī)學重點學科跟蹤項目(編號:GL2016069) 2015年河北省政府資助臨床醫(yī)學優(yōu)秀人才培養(yǎng)和基礎課題研究項目(編號:361009)
【分類號】：R687.3

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