[1]李启超 王永峰** 陕楠 刘儒星 赵斌 原杰 徐朝健.内镜辅助下经椎间孔病灶清除椎间融合术治疗腰椎布鲁杆菌脊柱炎11例[J].中国微创外科杂志,2023,01(8):616-623.
　Li Qichao,Wang Yongfeng,Shan Nan,et al.Endoscopic Assisted Transforaminal Lumbar Interbody Debridement and Fusion in the Treatment of 11 Cases of Lumbar Brucellus Spondylitis[J].Chinese Journal of Minimally Invasive Surgery,2023,01(8):616-623.
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内镜辅助下经椎间孔病灶清除椎间融合术治疗腰椎布鲁杆菌脊柱炎11例()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年8期
页码:
616-623
栏目:
经验交流
出版日期:
2023-08-25

文章信息/Info

Title:
Endoscopic Assisted Transforaminal Lumbar Interbody Debridement and Fusion in the Treatment of 11 Cases of Lumbar Brucellus Spondylitis
作者:
李启超 王永峰** 陕楠 刘儒星 赵斌 原杰 徐朝健
(山西医科大学第二医院脊柱外科，太原030001)
Author(s):
Li Qichao;  Wang Yongfeng;  Shan Nan;  et al.
Department of Spine Surgery, Second Hospital of Shanxi Medical University, Taiyuan 030001, China
关键词:
布鲁杆菌脊柱炎; 腰椎; 椎间融合术
Keywords:
Brucella spondylitis; Lumbar vertebra; Intervertebral fusion
文献标志码:
B
摘要:
目的探讨内镜辅助下经椎间孔病灶清除椎间融合术(transforaminal lumbar interbody debridement and fusion，TLIDF)治疗腰椎布鲁杆菌脊柱炎(lumbar brucellus spondylitis，LBS)的临床疗效。方法2021年3月~2022年9月我科采用内镜辅助下TLIDF治疗LBS 11例。C形臂透视下行术前定位：单侧双通道内镜椎间融合术(unilateral biportal endoscopic lumbar interbody fusion，UBELIF)确定椎弓根体表投影点，内镜辅助下经皮椎间融合术(percutaneous endoscopic lumbar interbody fusion，PELIF)定位棘突旁开距离。专用套管逐级扩张，内镜下清创、处理椎间隙，置入混有利福平的植骨颗粒，然后放置融合器，最后经皮置钉。结果11例均顺利完成手术，其中PELIF 3例，UBELIF 8例，无中转开放手术者。3例PELIF手术时间分别为140、200、260 min，术后带管时间均为2 d，术后总引流量分别为70、100、140 ml，住院时间分别为5、6、8 d，随访时间分别为6、14、18个月。8例UBELIF手术时间(170.0±49.1)min；术后带管时间(2.5±0.5)d；术后总引流量(93.5±55.7)ml；住院时间(8.1±1.1)d；随访时间6~13个月，(8.4±2.3)月。11例切口均Ⅰ期甲级愈合，均无复发，无脊髓、马尾神经损伤，未出现内固定移位及融合器塌陷。术前红细胞沉降率、C反应蛋白均大于正常值，末次随访时皆恢复至正常范围。腰背部与腿部疼痛视觉模拟评分(Visual Analogue Scale，VAS)和Oswestry功能障碍指数(Oswestry Disability Index，ODI)术后1、3个月和末次随访均明显小于术前(P<0.05)。末次随访根据改良MacNab标准，优7例，良3例，可1例，优良率90.9%(10/11)。美国脊髓损伤协会(American Spinal Injury Association，ASIA)分级术前8例D级，3例E级，末次随访11例均为E级。末次随访椎间植骨依据Eck骨融合分级，6例Ⅰ级融合，5例Ⅱ级融合。结论内镜辅助下TLIDF治疗LBS安全、可行。
Abstract:
ObjectiveTo investigate the clinical efficacy of endoscopic assisted transforaminal lumbar interbody debridement and fusion (TLIDF) in the treatment of lumbar brucellus spondylitis (LBS).Methods From March 2021 to September 2022, 11 cases of LBS were treated by endoscopic TLIDF. Preoperative localization was performed under the Carm fluoroscopy: the unilateral biportal endoscopic lumbar interbody fusion (UBELIF) was applied to determine the projection point of the pedicle surface, and the percutaneous endoscopic lumbar interbody fusion (PELIF) was carried out to locate the paraspinous process. The special cannula was gradually dilated. The debridement and treatment of intervertebral space were performed under endoscopy, the bone graft particles mixed with rifampicin were placed, then the fusion device was placed in, and finally percutaneous nailing was performed.ResultsThe operations were completed successfully in all the 11 cases, including 3 cases of PELIF and 8 cases of UBELIF, and there was no intraoperative conversion to open surgery. The operation time of 3 cases of PELIF was 140, 200, and 260 min, respectively, and the postoperative catheterization time was 2 d. The total postoperative drainage volume was 70, 100, and 140 ml, respectively. The hospitalization time was 5, 6, and 8 d, and the followup time was 6, 14, and 18 months, respectively. The operation time of 8 cases of UBELIF was (170.0±49.1) min, the postoperative catheterization time was (2.5±0.5) d, the total postoperative drainage volume was (93.5±55.7) ml, the hospitalization time was (8.1±1.1) d, and the followup time was 6-13 (mean, 8.4±2.3 months). All the 11 incisions healed by first intention with grade A, with no recurrence, no spinal cord or cauda equina nerve injury, and no internal fixation displacement or fusion device collapse. The preoperative erythrocyte sedimentation rate (ESR) and the Creactive protein (CRP) were both higher than the normal values and all returned to the normal range at the last followup. The visual analogue scale (VAS) and the Oswestry disability index (ODI) for pain in the lower back and legs were significantly lower than those before surgery at 1, 3 months and the last followup (P<0.05). At the last followup, according to the modified MacNab standard, 7 cases were excellent, 3 cases were good, and 1 case was fair. The excellent and good rate was 90.9% (10/11). The American Spinal Injury Association (ASIA) classified 8 cases as grade D, 3 cases as grade E before surgery, and 11 cases as grade E at the last followup. At the last followup, the intervertebral bone grafting showed 6 cases of grade Ⅰ fusion and 5 cases of grade Ⅱ fusion based on the Eck bone fusion grading. ConclusionEndoscopic assisted TLIDF for LBS are safe and feasible.

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备注/Memo

备注/Memo:
基金项目:山西省自然科学基金(20210302124670)**通讯作者,Email:wyfwf8@163.com
更新日期/Last Update: 2023-11-08