摘要
[目的]介绍腰椎布氏菌病经皮载药硫酸钙和椎弓钉固定的手术与治疗技术和初步临床结果。[方法]2017年7月—2021年7月对19例腰椎布氏杆菌病患者行上述手术治疗。一侧置入经皮椎弓根螺钉,另一侧安装MASTQuadrant通道系统,显露关节突关节及感染间隙,彻底清除病变组织。制备载药硫酸钙颗粒,并将其经通道置入病变间隙,用浸润有利福霉素的明胶海绵填塞覆盖。再置入同侧椎弓钉,完成椎弓钉固定。术后佩戴支具,进行康复功能锻炼。[结果]19例患者均顺利完成手术,无严重并发症。随访时间平均(18.3±8.7)个月,末次随访时ESR、CRP分别为(5.2±2.0)mm/h、(0.8±0.7)mg/L,VAS评分持续下降至(1.0±0.8)分。至末次随访所有患者均获得骨性愈合,无感染复发、内固定失败患者。[结论]在规范抗菌药物治疗的基础上,经皮载药硫酸钙和椎弓钉固定术微创,持续缓释放抗菌药物,利于感染控制,临床疗效确切。
[Objective]To present the surgical technique and preliminary clinical results of percutaneous drug-loaded calcium sulfateand pedicle screw fixation for lumbar brucellosis.[Methods]A total of 19 patients received abovementioned surgical treatment for lumbarbrulellosis from July 2017 to July 2021.After percutaneous pedicle screws were placed on the contralateral side,a MAST Quadrant channelsystem was installed on the affected side to expose the facet and the infected intervertebral space.The lesion was completely debrided,andthen the drug-loaded calcium sulfate particles were prepared and implanted through the channel into the affected intervertebral space,which finally covered with a gelatin sponge immersed with rifomycin.The pedicle screws were placed on the same side,and the screw-rodsystem was adjusted and fasten.After the operation,rehabilitation function exercise was conducted under protection with a brace.[Results]All the 19 patients were successfully operated on without serious complications,and followed up for(18.3±8.7)months in a mean.At the lat-est follow-up,all the patients got bony fusion of the affected space without infection recurrence and implant failure,associated with signifi-cant decrease of ESR,CRP and VAS score(P<0.05),whereas significant improvement in term of ASIA neurological function grade.[Con-clusion]On the basis of standardized antimicrobial therapy,percutaneous drug-loaded calcium sulfate and pedicle screw fixation are mini-mally invasive treatment,with continuous and slow release of antimicrobial drugs,which is conducive to infection control and has definiteclinical efficacy for lumbar brucella spondylitis.
作者
康冠
李继东
邱晓明
王克竞
张富强
张岁锋
程晴灏
闫亮
郭洪章
KANG Guan;Ll Ji-dong;QIUXiao-ming;WANG Ke-jing;ZHANG Fu-qiang;ZHANG Sui-feng;CHENG Qing-hao;YAN Liang;GUO Hong-zhang(People's Hospital of Gansu Province,Lanzhou 730000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2023年第23期2183-2187,共5页
Orthopedic Journal of China
基金
甘肃省自然科学基金项目(编号:22JR11RA244)。
关键词
布鲁氏杆菌性脊柱炎
载药硫酸钙
经皮椎弓根螺钉内固定
brucella spondylitis
drug-loaded calcium sulfate
percutaneous pedicle screw internal fixation
作者简介
康冠,主治医师,医学硕士,研究方向:脊柱脊髓,(电话)13919159016,(电子信箱)1050089393@qq.com;通信作者:郭洪章,(电话)18793191010,(电子信箱)g_hz@163.com。
