[1]唐建华**① 赵丽丽 黄春明 钟诚凡 刘付仟.椎间孔镜技术在腰椎间隙感染辅助治疗中的应用[J].中国微创外科杂志,2020,01(5):446-450.
　Tang Jianhua,Zhao Lili*,Huang Chunming*,et al.Effects of Transforaminal Endoscopic Surgery for Lumbar Intervertebral Infections[J].Chinese Journal of Minimally Invasive Surgery,2020,01(5):446-450.
点击复制

椎间孔镜技术在腰椎间隙感染辅助治疗中的应用()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年5期
页码:
446-450
栏目:
临床研究
出版日期:
2020-05-31

文章信息/Info

Title:
Effects of Transforaminal Endoscopic Surgery for Lumbar Intervertebral Infections
作者:
唐建华**① 赵丽丽 黄春明 钟诚凡 刘付仟
(高州市人民医院骨外科一区，高州525200)
Author(s):
Tang Jianhua;  Zhao Lili*;  Huang Chunming*;  et al.
*Department of Orthopedics, Gaozhou People’s Hospiital, Gaozhou 525200, China
关键词:
椎间孔镜技术; 腰椎间隙感染
Keywords:
Transforaminal endoscopic surgery; Lumber intervertebral infection
文献标志码:
A
摘要:
目的探讨椎间孔镜技术辅助抗生素治疗腰椎间隙感染的疗效。方法回顾性分析我科2010年11月~2017年4月28例腰椎间隙感染，观察组采用经皮椎间孔镜技术辅助抗生素治疗腰椎间隙感染15例，对照组采用抗生素及卧床保守治疗13例腰椎间隙感染，比较2组治疗前和治疗后2周、1个月、3个月、末次随访疼痛视觉模拟评分(Visual Analogue Scale,VAS)，日本骨科协会(Japanese Orthopaedic Association，JOA)评分及Oswestry功能障碍指数(Oswestry Disability Index，ODI)，末次随访采用改良MacNab标准评价疗效。结果观察组患者疼痛消失时间(3.6±1.3)周，明显短于对照组(7.1±0.7)周(t=-8.645，P=0.000)；红细胞沉降率正常时间(4.4±1.7)周，显著短于对照组(9.8±1.1)周(t=-10.134，P=0000)；观察组C-反应蛋白转阴时间(3.6±1.3)周，显著短于对照组(8.2±0.9)周(t=-10.851, P=0.000)。观察组治疗后2周、1个月、3个月疼痛VAS评分明显低于对照组(P<0.05),2组末次随访疼痛VAS评分无统计学差异(P>0.05)；ODI和JOA评分组间、时间和组间与时间的交互作用差异均有显著性(P<0.05)。28例随访12~24个月，平均13.7月，观察组和治疗组末次随访改良MacNab疗效优良率分别为93.3%(14/15)、76.9%(10/13)，差异无显著性(Z=-1.270，P=0.204)。结论椎间孔镜技术辅助抗生素治疗腰椎间隙感染简便，创伤小，是一种安全有效的方法。
Abstract:
ObjectiveTo explore the efficacy of percutaneous transforaminal endoscopic surgery in the treatment of lumbar intervertebral infections.MethodsA retrospective analysis was made on 28 cases of patients with lumbar intervertebral infections in our hospital from November 2010 to April 2017. The observation group (n=15) was treated with percutaneous transforaminal endoscopic surgery combined with antibacterial therapy. The control group (n=13) was given injection of antibiotics and conservative bed rest. The Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI) were compared at preoperation, 2 weeks, 1 month, and 3 months after operation, and the last followup between the two groups. The modified MacNab criteria was used to evaluate the efficacy at the end of the followup.ResultsThe time of disappearance of pain in the control group was (7.1±0.7) weeks, which was longer than (3.6±1.3) weeks in the observation group, with significant different (t=-8.645, P=0.000). The time of normal erythrocyte sedimentation rate in the control group was (9.8±1.1) weeks, which was longer than (4.4±1.7) weeks in the observation group, and the time of negative Creactive protein in the control group was (8.2±0.9) weeks, which was longer than (3.6±1.3) weeks in the observation group (t=-10.134, P=0.000; t=-10.851, P=0.000). The VAS scores of pain in the observation group was significantly lower than that in the control group at 2 weeks, 1 month and 3 months after treatment (P<0.05). There was no significant difference between the two groups at the last followup (P>0.05). There were significant differences in the ODI and JOA scores among groups, at different time points within groups, and interaction between groups and time (P<0.05). All the 28 cases were followed up for 12-24 months, with an average of 13.7 months. According to the modified MacNab criteria, the overall excellent and good rate in the observation group and the control group were 933%(14/15) and 76.9%(10/13), respectively. There was no significant difference (Z=-1.270, P=0.204).ConclusionCombined with antibacterial therapy, percutaneous transforaminal endoscopic surgery to treat lumbar intervertebral space infections is a safe and effective method.

参考文献/References:

[1]Wang K, Hong X, Zhou BY, et al. Evaluation of transforaminal endscopic lumbar discectomy in the treatment of lumbar disc herniation. Int Orthop,2015,39(8):1599-1604.
[2]MacNab I. Negative disc exploration: An analysis of the causes of nerve root involvement in sixtyeight patients. J Bone Surg Am,1971,53(5):891-903.
[3]Alexander G, Hadjipavlou AG, Mader JT, et al. Hematogenous pyogenic spinal infections and their surgical management. Spine,2002,25(13):1668-1679.
[4]Lurie JD, Moses RA, Tosteson AN, et al. Magnetic resonance imaging predictors of surgical outcome in patients with lumbar inervertebar disc herniation. Spine (Phila Pa 1976),2013,38(14):1216-1225.
[5]戴守达,董小雄,张耘,等.病灶清除加一期或二期后路椎弓根系统内固定治疗腰椎结核.中国矫形外杂志,2011,22(23):2010-2012.
[6]徐勇，李锋，熊伟,等.一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染.中国脊柱脊髓杂志,2016,26(9):827-832.
[7]郭超峰，张宏其，高琪乐,等.单纯后路Ⅰ期病灶清除椎间钛网植骨融合内固定治疗成人腰椎结核.中国骨伤,2017,30(5):406-410.
[8]张玉坤,黄卫民,田慧中,等.一期后路病灶清除椎间植骨融合内固定治疗原发性腰椎间隙感染.中国矫形外科杂志,2013,21(7):714-716.
[9]赵宏，李纯志，芳煜，等.椎间孔镜Maxmore技术治疗青少年腰椎间盘突出症.中国微创外科杂志，2017,17(5)：432-436.
[10]张西峰,王岩,肖嵩华,等．皮穿刺置管冲洗引流持续局部化疗治疗活动期多椎体脊柱结核.中国脊柱脊髓杂志,2007,17(11):842-845.
[11]张宏其,尹新华,刘少华,等．CT引导下经皮穿刺置管灌洗治疗小儿腰骶段结核.中国脊柱脊髓杂志,2013,23(6):504-507.

备注/Memo

备注/Memo:
基金项目：2018年茂名市科技计划项目（2018202）**通讯作者，Email:tangjianhua4161@163.com①(东莞市长安医院骨科，东莞523843)
更新日期/Last Update: 2020-08-08