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中华临床医师杂志(电子版) ›› 2020, Vol. 14 ›› Issue (07) : 552 -556. doi: 10.3877/cma.j.issn.1674-0785.2020.07.017

所属专题: 文献

临床研究

一期后路手术治疗合并硬膜外脓肿的腰椎布鲁氏菌脊柱炎
李辉映1, 王永恒1, 王春2, 张功林3,()   
  1. 1. 734000 甘肃张掖,河西学院附属张掖人民医院骨科
    2. 734000 甘肃张掖,河西学院附属张掖人民医院急诊科
    3. 730000 甘肃兰州,解放军940医院骨科研究所
  • 收稿日期:2020-02-02 出版日期:2020-07-15
  • 通信作者: 张功林
  • 基金资助:
    河西学院科研创新与应用校长基金(XZ2016004)

One-stage posterior surgery for treatment of lumbar brucellar spondylitis with epidural abscess

Huiying Li1, Yongheng Wang1, Chun Wang2, Gonglin Zhang3,()   

  1. 1. Departmentof Orthopaedics, Zhangye People′s Hospital Affiliated to Hexi College, Zhangye 734000, China
    2. Department of Emergency, Zhangye People′s Hospital Affiliated to Hexi College, Zhangye 734000, China
    3. Orthopaedics Research Institution of 940 Hospital of Chinese PLA, Lanzhou 730000, China
  • Received:2020-02-02 Published:2020-07-15
  • Corresponding author: Gonglin Zhang
  • About author:
    Corresponding author: Zhang Gonglin, Email:
引用本文:

李辉映, 王永恒, 王春, 张功林. 一期后路手术治疗合并硬膜外脓肿的腰椎布鲁氏菌脊柱炎[J]. 中华临床医师杂志(电子版), 2020, 14(07): 552-556.

Huiying Li, Yongheng Wang, Chun Wang, Gonglin Zhang. One-stage posterior surgery for treatment of lumbar brucellar spondylitis with epidural abscess[J]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(07): 552-556.

目的

总结一期后路手术治疗合并硬膜外脓肿的腰椎布鲁氏菌脊柱炎的临床疗效。

方法

选择2014年1月至2018年12月应用一期后路手术治疗腰椎布鲁氏菌脊柱炎伴硬膜外脓肿23例,在规范抗布鲁氏菌病基础上,采用后路病灶清除、椎板减压、短节段固定及椎间植骨融合方法进行治疗。观察患者术后腰腿痛减轻及植骨融合情况。

结果

术后23例均获随访,随访时间平均(16.28±3.26)个月,术后切口均一期愈合,布鲁氏菌病的症状消失,内固定牢固,植骨融合时间(7.42±1.26)个月。按Nakano等提出的腰背痛手术疗效标准:优,16例;良,5例;可,2例。

结论

对合并硬膜外脓肿的腰椎布鲁氏菌脊柱炎在规范抗感染治疗的基础上,行一期后路病灶清除、短节段固定及植骨融合可取得较满意的效果。

Objective

To assess the safety and efficacy of one-stage posterior surgery in the treatment of lumbar brucellar spondylitis with epidural abscess.

Methods

A retrospective analysis was performed on 23 cases of lumbar brucellar spondylitis patients who were treated by one-stage posterior radical debridement, lamina decompression, short segment internal fixation, and intervertebral fusion from January 2014 to December 2018.

Results

The 23 patients were followed for an average period of (16.28±3.26) months. All the incisions achieved primary healing. There was no loss, breakage, or loosening of internal fixation. The brucellosis spondylitis symptoms disappeared in all patients. According to the operative efficacy criteria proposed by Nakano et al for low back pain, the results were excellent in 16 cases, good in 5 cases, and fair in 2 cases. The bone graft fusion time was (7.42±1.26) months.

Conclusion

On the basis of standard anti-brucellosis chemotherapy, one-stage clearance of lesions, posterior debridement, short segment of internal fixation, and intervertebral fusion are a safe and effective surgical method for lumbar brucellar spondylitis with epidural abscess.

图1~9 患者女性,46岁,因间歇性腰痛伴双下肢放射性疼痛2年,双下肢行走无力1个月 图1、2为入院术前X线正侧片显示L4~5椎间隙狭窄、硬化;图3、4为CT示L4、L5椎体边缘、后缘多个破坏灶;图5、6为MRI示L4、L5椎体骨髓水肿,椎管内硬膜前方脓肿,压迫脊髓明显、椎旁脓肿;图7为术后组织病理学检查(HE染色,×100)示病变区组织细胞结节性增生、肉芽肿形成;图8、9为术后6个月X线正侧片示L4~5椎间植骨融合,内固定良好
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