文章摘要
黄群,朱现玮,严飞,等.经皮椎间孔镜下病灶清除治疗腰椎间隙感染的疗效分析.骨科,2022,13(2): 97-101.
经皮椎间孔镜下病灶清除治疗腰椎间隙感染的疗效分析
Efficacy of Percutaneous Endoscopic Debridement on Lumbar Intervertebral Infections
投稿时间:2021-06-08  
DOI:10.3969/j.issn.1674-8573.2022.02.001
中文关键词: 腰椎间隙感染  经皮内镜清创术  病灶清除  引流
英文关键词: Lumbar intervertebral infection  Percutaneous endoscopic debridement  Lesion clearance  Drainage
基金项目:国家自然科学基金(81874008)
作者单位E-mail
黄群 苏州大学附属张家港医院骨科江苏张家港 215600  
朱现玮 苏州大学附属张家港医院骨科江苏张家港 215600  
严飞 苏州大学附属张家港医院骨科江苏张家港 215600 727570771@qq.com 
徐炜 苏州大学附属张家港医院骨科江苏张家港 215600  
徐沁 苏州大学附属张家港医院骨科江苏张家港 215600  
周志平 苏州大学附属张家港医院骨科江苏张家港 215600  
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中文摘要:
      目的 分析经皮椎间孔镜下病灶清除引流术治疗腰椎间隙感染的临床疗效。方法 回顾性分析2016年11月至2019年9月我院经皮椎间孔镜下病灶清除治疗的14例腰椎间隙感染病人的临床资料。统计分析病人术前和术后1周、1个月、3个月疼痛视觉模拟量表(visual analogue scale,VAS)评分、日本骨科协会(Japanese Orthopaedic Association,JOA)评分、Oswestry功能障碍指数(Oswestry disability index,ODI),采用改良MacNab疗效评定标准对手术疗效进行评估。结果 14例病人均获得随访,随访时间为(13.57±2.56)个月。术后1周,白细胞、中性粒细胞百分比、C-反应蛋白、红细胞沉降率均明显低于术前,差异有统计学意义(P<0.05)。末次随访时,上述指标均恢复至正常范围。所有病人术后症状均明显减轻,术后1周VAS评分[(3.39±0.53)分]和术后3个月VAS评分[(1.46±0.41)分]均明显低于术前[(6.96±0.69)分],差异有统计学意义(P<0.05)。病人术后1周ODI降至(46.79±5.18)%,术后3个月为(15.71±2.58)%,病人术后腰椎功能明显改善,与术前[(69.43±1.89)%]比较,差异有统计学意义(P<0.05)。病人术后1周JOA评分为(19.21±1.76)分,术后3个月为(27.43±2.94)分,与术前[(8.71±1.68)分]比较,差异有统计学意义(P<0.05)。根据改良MacNab标准,优9例,良3例,可1例,差1例,优良率为85.71%。术后1个月复查腰椎MRI显示脓肿已清除,神经根及硬膜囊无受压,部分病例达到椎间骨性融合。结论 经皮椎间孔镜下病灶置管引流操作简单、创伤小,术后症状明显改善,对于治疗腰椎间隙感染是一种安全有效的方法。
英文摘要:
      Objective To analyze the clinical effectiveness of percutaneous endoscopic debridement on lumbar intervertebral infections. Methods A retrospective analysis was performed on 14 cases of lumbar intervertebral infections treated by percutaneous endoscopic debridement in our hospital from November 2016 to September 2019. Sensitive antibiotics were given according to the results of bacterial culture after operation. The clinical efficacy was evaluated by visual analog scale (VAS), Japanese Orthopaedic Association (JOA), Oswestry disability index (ODI), and standard MacNab's evaluation. Results All patients were followed up for (13.57±2.56) months. One week postoperatively, white blood cells (WBC), a fractional fraction of medium granulocytes, ESR and CRP were significantly lower than pre-operation (P<0.05). At the last follow-up, the above-mentioned markers all recovered to normal range. The postoperative symptoms of all patients were significantly alleviated. The VAS score (3.39±0.53) at 1 week and (1.46±0.41) 3 months after operation were significantly lower than that before operation (6.96±0.69), and the difference was statistically significant (P<0.05). The ODI of the patient decreased to (46.79±5.18) % one week after operation and (15.71±2.58) % 3 months after operation. The lumbar function of the patient was significantly improved after operation, which was significantly different from that before operation [(69.43±1.89) %, P<0.05]. The JOA score of the patient was (19.21±1.76) one week after operation and (27.43±2.94) 3 months after operation, which was significantly different from that before operation (8.71±1.68, P<0.05). According to the MacNab criteria, the efficacy was excellent in 9 cases, good in 3 cases and fair in 1 case, with an excellent and good rate of 85.71%. Postoperative MRI showed that the abscess disappeared. Conclusion Percutaneous endoscopic debridement is a safe and effective method for lumbar intervertebral infection, which is less traumatic and significantly improved postoperative symptoms.
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