椎间孔入路病灶清除、植骨融合、椎弓根钉内固定治疗腰椎布氏杆菌性脊柱炎的疗效分析
Efficacy of thoracolumbar single segment of Brucella spondylitis TLIF surgery

摘要：目的 探讨经椎间孔入路病灶清除、植骨融合、椎弓根钉内固定(TLIF手术)治疗腰椎布氏杆菌性脊柱炎的临床疗效。方法 回顾分析2009年1月-2014年1月我科采用TLIF手术(A组)和单纯后路内固定联合一期前路病椎间病灶清除、自体髂骨植骨术(B组)治疗的28例布氏杆菌性脊柱炎患者的临床资料，对比分析两组的手术时间、术中出血量、术后下地时间、住院天数、红细胞沉降率(ESR)、C反应蛋白(CRP)、神经功能美国脊髓损伤学会(ASIA)分级、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、病椎Cobb角、植骨愈合情况及术后并发症等情况。结果 所有患者均获随访，平均随访时间20.2个月(18～27个月)；所有患者均治愈。与B组相比，A组患者的手术时间(164.60±59.19)min、术中出血量(346.00±108.90)mL及并发症(1例)显著减少；术后患者下地时间(3.36±1.11)d、住院天数(17.36±4.19)d及病程(13.16±3.94)个月明显缩短，且两组之间的差异具有统计学意义(P<0.05)。两组VAS评分、ODI、ESR、CRP、Cobb角的比较差异无统计学意义(P>0.05)。结论 在规范抗布氏杆菌药物治疗的基础上，TLIF手术治疗布氏杆菌性脊柱炎手术创伤小、手术时间短、易操作、出血少、术后下地时间早及并发症发生率更低。
ABSTRACT: Objective To investigate clinical efficacy of transforaminal approach debridement with fusion, thoracolumbar single segment of Brucella spondylitis pedicle screw fixation (TLIF surgery). Methods We analyzed retrospectively the clinical data of 28 patients with Brucella spondylitis treated in our department between January 2009 and January 2014 with TLIF surgery (Group A) and internal fixation with a simple posterior anterior interbody disease debridement, autogenous bone graft (Group B). The two groups were compared in operation time, blood loss, postoperative ambulation time, hospitalization days, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) classification, visual analogue scale (VAS), Oswestry Disability Index (ODI), Cobb angle of vertebral bone graft healing, and complications. Results All the patients were followed up for an average of 20.2 months (18 to 27 months). They were all cured. Compared with those in Group B, patients in Group A had shorter operation time (164.60±59.19)min, significantly reduced blood loss (346.00±108.90)mL and complications (1 case); significantly shorter postoperative ambulation time (3.36±1.11 days), hospitalization days (17.36±4.19) days and duration (13.16±3.94) months (P<0.05). The two groups did not significantly differ in VAS scores, ODI, ESR CRP, or Cobb angle (P>0.05). Conclusion On the basis of norms of anti-drug treatment for brucellosis, TLIF surgery on Brucella spondylitis has the advantages including less trauma, shorter operation time, easier operation, less bleeding, earlier postoperative ambulation, and lower complication rate