后路病灶清除椎间植骨融合内固定术治疗原发性腰椎间盘炎  被引量:1

Posterior debridement,interbody fusion,internal fixation for treatment of lumbar discitis

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作  者:陈林 程军 李波 占方彪 张友 冯世龙 CHEN Lin, CHENG Jun,LI Bo,ZHAN Fang-biao,ZHANG You,and FENG Shi-long. (Department of Spinal Surgery,Central Hospital of the Three Changjiang River Gorges of Chongqing, Chongqing 404000, China)

机构地区:重庆三峡中心医院脊柱外科,重庆404000

出  处:《中国骨伤》2017年第5期475-478,共4页China Journal of Orthopaedics and Traumatology

摘  要:目的:探讨Ⅰ期后路病灶清除椎间植骨融合内固定治疗原发性腰椎间盘炎的临床疗效。方法:回顾性分析2005年1月至2012年6月收治的原发性腰椎间盘炎13例,其中男9例,女4例;年龄31~68岁,平均56岁;L_(3,4)间隙2例,L_(4,5)间隙4例,L_5S_1间隙7例。伴有糖尿病2例,高血压4例,陈旧性肺结核1例。血沉(ESR)为12~89 mm/h,平均42 mm/h;C-反应蛋白8~114 ng/L,平均47 ng/L。13例患者均无手术及穿刺病史,腰部剧烈疼痛,活动受限,保守治疗无效。术前视觉模拟评分(VAS)评分5~10分,平均7.8分,行后路病灶清除椎间植骨融合内固定手术。结果:术后患者伤口愈合满意出院,持续有效抗生素静脉使用4周,口服抗生素2周。所有病例获得随访,时间7~24个月,平均18个月。VAS评分0~1分,无内固定断裂、复发患者,植骨均融合,术后病理检查均提示炎症性改变。结论 :Ⅰ期后路病灶清除椎间植骨融合内固定术治疗原发性腰椎间盘炎疗效确切,可较快缓解疼痛,早期活动。Objective: To evaluate the clinical effects of posterior debridement,interbody fusion with internal fixation in the treatment of lumbar discitis.Methods: The clinical data of 13 patients with lumbar discitis treated from January 2005 to June 2012 was retrospectively analyzed. There were 9 males and 4 females,aged from 31 to 68 years old with an average of 56 years old. There were 2 cases on L3,4,4 cases on L4,5,and 7 cases on L5S1. Two cases complicated with diabetes,4 cases with hypertension,and 1 case with obsolete pulmonary tuberculosis. ESR level of 13 cases was 12-89 mm/h with an average of 42 mm/h;and C reactive protein fluctuations level was level 8-114 ng/L with an average of 47 ng/L. All the patients denied history of operation or injection,and the main symptom was severe pain and limitation of motion in lumbar,with no efficacy for conservative methods. Preoperative VAS was from 5 to 10 points with an average of 7.8 points. All patients were treated with posterior debridement,interbody fusion,and internal fixation.Results: All the patients left hospital after wound healing,and the effective antibiotics were continuously used for 4 weeks intravenously and 2 weeks for orally. All patients were followed up from 7 to 24 months with an average of 18 months. VAS decreased for 0-1 point. No internal fixation breakage,and recurrence were found. Bone graft got fusion,and postoperative pathology showed phlogistic changes.Conclusion: One-stage posterior debridement,interbody fusion with internal fixation was an effective method in treating lumbar discitis,and it lead to quicker relived pain relief and earlier mobilization.

关 键 词:腰椎 椎间盘 炎症 清创术 脊柱融合术 内固定 

分 类 号:R681.530.5[医药卫生—骨科学;医药卫生—临床医学;医药卫生—外科学]

 

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