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椎间孔镜治疗单节段非特异性腰椎间隙感染的效果分析

李由 丁恒 崔亮 赵元曦 展恩雨 李兴国

李由, 丁恒, 崔亮, 赵元曦, 展恩雨, 李兴国. 椎间孔镜治疗单节段非特异性腰椎间隙感染的效果分析[J]. 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20240515
引用本文: 李由, 丁恒, 崔亮, 赵元曦, 展恩雨, 李兴国. 椎间孔镜治疗单节段非特异性腰椎间隙感染的效果分析[J]. 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20240515
You LI, Heng DING, Liang CUI, Yuanxi ZHAO, Enyu ZHAN, Xingguo LI. The Analysis of the Therapeutic Effect of Intervertebral Foramen Endoscopy on Single Segment Non-specific Lumbar Intervertebral Space Infection[J]. Journal of Kunming Medical University. doi: 10.12259/j.issn.2095-610X.S20240515
Citation: You LI, Heng DING, Liang CUI, Yuanxi ZHAO, Enyu ZHAN, Xingguo LI. The Analysis of the Therapeutic Effect of Intervertebral Foramen Endoscopy on Single Segment Non-specific Lumbar Intervertebral Space Infection[J]. Journal of Kunming Medical University. doi: 10.12259/j.issn.2095-610X.S20240515

椎间孔镜治疗单节段非特异性腰椎间隙感染的效果分析

doi: 10.12259/j.issn.2095-610X.S20240515
基金项目: 云南省科技厅重大科技专项计划——云南省骨科与运动康复临床医学研究中心,项目编号:202102AA310068;云南省应用基础研究(昆医联合专项);项目编号:202101AY070001-120;云南省高层次卫生计生技术人才-医学学科后备人才项目;项目编号: H-2019012
详细信息
    作者简介:

    李由(1996~),男,蒙古族,黑龙江五大连池人,在读硕士研究生,住院医师,主要从事脊柱相关性疾病诊疗工作

    通讯作者:

    李兴国,E-mail:yunnanlxg@163.com

  • 中图分类号: R687.3

The Analysis of the Therapeutic Effect of Intervertebral Foramen Endoscopy on Single Segment Non-specific Lumbar Intervertebral Space Infection

  • 摘要:   目的  通过观察后外侧入路椎间孔镜技术与后路腰椎病灶清除植骨融合内固定术治疗单节段非特异性腰椎间隙感染的临床结果,评估后外侧入路椎间孔镜治疗单节段非特异性腰椎间隙感染的疗效和优势。   方法  对昆明医科大学第一附属医院骨科2016年6月至2023年6月收治的42例非特异性腰椎间隙感染患者的临床资料进行回顾性分析。男24例,女18例,平均54岁,分为A、B 2组,每组21例,A组患者均行后外侧经皮椎间孔镜下清创术,联合软组织浸泡法提高病原学检出率。B组患者均行后路腰椎病灶清除植骨融合内固定术,对比分析手术前后腰痛视觉模拟量表评分(VAS)、日本骨科协会腰椎评分(JOA)、腰椎ODI量表评估患者临床症状缓解情况,白细胞、超敏C反应蛋白、血沉等感染指标,病原耐药菌的治疗效果、细菌培养率和术后并发症。  结果  采用后外侧经皮椎间孔镜下清创术联合软组织浸泡法,获取病原菌培养阳性率为90%。A/B组的VAS、JOA、ODI,术后1周、末次随访与术前相比均有改善。术后7 d的JOA评分A组分数高于B组,且差异有统计学意义(P < 0.05);术后7 d的ODI评分A组低于B组,且差异有统计学意义(P < 0.05)。感染指标中,CRP、ESR在术后3 d、术后7 d、A组远小于B组,且逐渐下降,差异有统计学意义(P < 0.05)。  结论  后外侧入路椎间孔镜技术治疗腰椎间隙感染结合软组织浸泡法细菌培养率高、可有效减轻患者疼痛,提高生活质量;明显降低感染指标;对于高龄基础疾病多、细菌毒力强、高热、炎症指标较高、预估置入内固定物感染风险较高、不能耐受全麻手术的的高危患者人群安全有效。
  • 图  2  典型病例

    a:X线显示术前L2/3/4椎体变扁;b:CT示L3、4椎体破坏严重;c:术前CT横断面L3/4椎间隙;d~e:术前MR示L3、L4椎体及间隙信号异常,椎管狭窄;h:术中镜下清除感染及坏死组织;f~g:术后MR示相应节段椎管容积扩大,异常信号缩小;i:药敏报告;j:骨扫描诊断。

    Figure  2.  Tipical case

    图  1  药敏图谱

    a:耐甲氧西林金黄色葡萄球菌;b:耐甲氧西林沃氏葡萄球菌;c:大肠埃希菌;d:嗜麦芽窄食单胞菌。

    Figure  1.  Drug sensitivity chart

    表  1  组内临床指标比较

    Table  1.   Comparison of clinical indicators within groups

    指标术前术后7 d末次随访FP
    A组
     VAS6.05±2.312.43±1.78a0.52±0.51ab132.27<0.001*
     JOA12.34±3.3218.57±3.99a24.95±2.78ab285.36<0.001*
     ODI49±16.6333.81±13.58a9.62±3.12ab109.58<0.001*
    B组
     VAS5.19±1.542.43±1.03a0.38±0.50ab135.93<0.001*
     JOA14.38±5.0815.62±3.3225.29±1.71ab69.20<0.001*
     ODI58.14±15.0755.43±18.2613.86±3.31ab87.04<0.001*
      与同组术前比较,aP < 0.05;与同组术后7 d比较,bP < 0.05;*P < 0.05。
    下载: 导出CSV

    表  2  组间临床指标比较

    Table  2.   Comparison of clinical indicators between groups

    指标ABtP
    VAS
     术前6.05±2.315.19±1.541.41500.164
     术后7 d2.43±1.782.43±1.030.90.373
     末次随访0.52±0.510.38±0.500.9170.364
    JOA
     术前12.34±3.3214.38±5.08−1.5450.130
     术后7 d18.57±3.9915.62±3.322.6040.013*
     末次随访24.95±2.7825.29±1.71−0.4680.642
    ODI
     术前49±16.6358.14±15.07−1.8670.069
     术后7 d33.81±13.5855.43±18.26−4.271<0.001*
     末次随访12.62±3.1213.86±3.31−1.2490.219
      *P < 0.05。
    下载: 导出CSV

    表  3  组内感染指标比较[M(P25P75)]

    Table  3.   Comparison of infection indicators within groups [M(P25P75)]

    指标术前术后3 d术后7 d术后1月HP
    A组
     CRP43.6(8.9,51.85)26.3(9.99,35.95)14.4(4.65,31.28)a2.6(1.25,17.75)a15.3470.002*
     ESR69(15.5,83)40(11.5,69.5)23(9,66.5)a12(4,25)a14.8930.002*
     WBC5.6(4.65,7.25)5.7(4.85,7.8)6(5.45,8.2)6(5,7.25)1.1800.758
    B组
     CRP30(4.3,53.55)71.7(36.75,104)a41.8(27.6,54.45)7(3.6,1.25)a32.725<0.001*
     ESR53(29,84.5)61(34,79.5)56(47.5,77.5)14(11,41.5)a16.691<0.001*
     WBC5.8(5.2,8.45)8.1(5.85,9.9)7.3(5.15,8.25)5.6(5,6.9)6.7080.082
      与同组术前比较,aP < 0.05;*P < 0.05。
    下载: 导出CSV

    表  4  组间感染指标比较[M(P25P75)]

    Table  4.   Comparison of infection indicators between groups [M(P25P75)]

    指标A组B组ZP
    CRP
     术前43.6(8.9,51.85)30(4.3,53.55)-0.6920.489
     术后3 d26.3(9.99,35.95)71.7(36.75,104)-3.685<0.001*
     术后7 d14.4(4.65,31.28)41.8(27.6,54.45)-3.535<0.001*
     术后1月2.6(1.25,17.75)7(3.6,1.25)-1.4850.138
    ESR
     术前69(15.5,83)53(29,84.5)-0.5030.615
     术后3 d40(11.5,69.5)61(34,79.5)-2.0630.039*
     术后7 d23(9,66.5)56(47.5,77.5)-2.4160.016*
     术后1月12(4,25)14(11,41.5)-1.6520.099
    WBC
     术前5.6(4.65,7.25)5.8(5.2,8.45)-0.9310.352
     术后3 d5.7(4.85,7.8)8.1(5.85,9.9)-2.2400.025*
     术后7 d6(5.45,8.2)7.3(5.15,8.25)-0.6170.537
     术后1月6(5,7.25)5.6(5,6.9)-0.5810.561
      *P < 0.05。
    下载: 导出CSV

    表  5  42例化脓性脊柱炎细菌型频数分布

    Table  5.   Frequency distribution of bacterial types in 42 cases of suppurative spondylitis

    细菌类型n耐药菌数耐药抗生素
    革兰阳性菌和杆菌21
    金黄色葡萄球菌52青霉素、头孢类、红霉素、克林霉素*
    沃氏葡萄球菌32青霉素、左氧氟沙星、莫西沙星*
    粪肠球菌1
    表皮葡萄球菌71青霉素、红霉素、四环素、苯唑西林
    人葡萄球菌2
    戈登链球菌1
    革兰阴性菌杆菌16
    大肠埃希菌84左氧氟沙星、复方新诺明、环丙沙星、头孢曲松*
    嗜麦芽单胞菌11头孢哌酮舒巴坦*
    伤寒杆菌3
    大田苍白杆菌1
    未知类型细菌5
    共计42
      *表示见图1药敏菌谱。
    下载: 导出CSV
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出版历程
  • 收稿日期:  2024-01-11
  • 网络出版日期:  2024-04-29

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