文章摘要
陈志达,宋超,林斌,等.斜外侧椎间融合术治疗单节段非特异性腰椎间隙感染的临床疗效分析.骨科,2022,13(2): 102-109.
斜外侧椎间融合术治疗单节段非特异性腰椎间隙感染的临床疗效分析
Clinical Application of Oblique Lateral Interbody Fusion in Lumbar Pyogenic Spondylodiscitis
投稿时间:2021-07-01  
DOI:10.3969/j.issn.1674-8573.2022.02.002
中文关键词: 斜外侧椎间融合术  非特异性腰椎间隙感染  单节段  疗效
英文关键词: Oblique lumbar interbody fusion  Lumbar pyogenic spondylodiscitis  Single segment  Clinical efficacy
基金项目:漳州市自然科学基金(ZZ2018J10),全军军事训练伤防治研究专项(21XLS23)
作者单位E-mail
陈志达 中国人民解放军联勤保障部队第909医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000  
宋超 中国人民解放军联勤保障部队第909医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000 songchao930915@163.com 
林斌 中国人民解放军联勤保障部队第909医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000  
蔡弢艺 中国人民解放军联勤保障部队第909医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000  
蒋元杰 中国人民解放军联勤保障部队第909医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000  
涂承权 中国人民解放军联勤保障部队第909医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000  
黄锡明 中国人民解放军联勤保障部队第909医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000  
胡晓阳 中国人民解放军联勤保障部队第909医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000  
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中文摘要:
      目的 研究斜外侧椎间融合术(oblique lumbar interbody fusion,OLIF)治疗单节段非特异性腰椎间隙感染的临床疗效。方法 回顾性分析我院2014年1月至2018年11月应用OLIF单一切口完成病灶清创、髂骨植骨、侧方螺钉内固定治疗的32例单节段非特异性腰椎间隙感染病人的临床资料,其中男21例,女11例,年龄为(59.0±1.9)岁(38~78岁)。感染节段分布:L1/2 2例,L2/3 7例,L3/4 13例,L4/5 10例。术前Pola分型A.3型3例,A.4型1例,B.1型13例,B.2型7例,B.3型2例,C.1型6例。术前美国脊髓损伤协会(American Spinal Injury Association,ASIA)分级:C级2例,D级4例,E级26例。记录病人手术时间、术中出血量、病原学培养结果、住院天数。收集病人术前、术后3个月及18个月的疼痛视觉模拟量表(visual analogue scale,VAS)评分,Oswestry功能障碍指数(Oswestry disability index,ODI),白细胞(WBC)计数、C-反应蛋白(CRP)、红细胞沉降率(ESR)、降钙素原(PCT)等炎症指标,整体腰椎前凸角(GLL)、椎间盘高度(DSH)、局部腰椎前凸角(SLL)等影像学参数,并观察手术并发症及融合情况。结果 所有病人均顺利完成手术,手术时间为(92.8±12.4)min,术中出血量为(108.5±32.9) mL。术前共有10例病人行CT引导下穿刺标本细菌培养,检出阳性结果6例(6/10,60.0%),术中标本送检培养出阳性病原菌25例(25/32,78.1%)。住院时间为(13.6±2.1)d,随访时间为(21.1±2.0)个月。术后3个月、18个月随访时VAS、ODI较术前明显减少,差异有统计学意义(P<0.05);术后3个月、18个月WBC、CRP、ESR、PCT均较术前降低,差异有统计学意义(P<0.05),术后3个月、18个月GLL、DSH、SLL较术前增加,差异有统计学意义(P<0.05)。仅1例ASIA分级D级病人未完全恢复,余均恢复至E级,所有病人末次随访时均达到了骨性融合,未出现手术相关并发症。结论 OLIF技术治疗单节段非特异性腰椎间隙感染可以取得良好的临床及影像学效果,尤其对于Pola A.3~C.1型感染病例疗效确切,值得进一步推广应用。
英文摘要:
      Objective To explore the clinical efficacy of oblique lumbar interbody fusion (OLIF) in the treatment of single segment lumbar pyogenic spondylodiscitis. Methods From January 2014 to November 2018, patients with single level lumbar pyogenic spondylodiscitis treated by OLIF which contained debridement, iliac bone grafting and lateral screw fixation in our hospital were retrospectively analyzed. There were 21 males and 11 females with age of (59.0±1.9) years (38-78 years). There were 2 cases of L1/2, 7 cases of L2/3, 13 cases of L3/4 and 10 cases of L4/5. Preoperative Pola type included 3 cases of A.3 type, 1 case of A.4 type, 13 cases of B.1 type, 7 cases of B.2 type, 2 cases of B.3 type and 6 cases of C.1 type. Preoperative American Spinal Injury Association (ASIA) included 2 cases of C grade, 4 cases of D grade and 26 cases of E grade. Operation time, intraoperative blood loss, pathogen culture results and hospital days were recorded. The visual analogue scale (VAS), Oswestry disability index (ODI), white blood cell (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), global lumbar lordosis angle (GLL), disc space height (DSH), segmental lumbar lordosis angle (SLL), as well as complications and fusion before and 3 months and 18 months after operation were collected. Results All patients completed the operation successfully and the operation time was (92.8±12.4) min, the intraoperative blood loss was (108.5±32.9) mL. A total of 10 patients underwent CT guided bacterial culture of puncture specimens before operation and 6 cases (6/10, 60.0%) were positive. A total of 25 cases (25/32, 78.1%) of pathogens were detected by intraoperative culture. The hospital day was (13.6±2.1) d and the follow-up time was (21.1±2.0) months. At 3 and 18 months of follow-up, VAS and ODI were significantly lower than those before operation (P<0.05), and WBC, CRP, ESR and PCT were also significantly lower than those before operation (P<0.05), GLL, DSH and SLL were significantly higher than those before operation (P<0.05). There were only 1 case of D grade who did not recover completely at 18 months postoperation. All patients achieved bone fusion and no operation related complications occurred at the last follow-up. Conclusion OLIF in the treatment of single segment lumbar pyogenic spondylodiscitis can achieve good clinical and imaging results, especially for Pola type A.3-C.1 type. This is worthy of further promotion and application.
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