前路或前后路联合手术治疗颈椎布鲁杆菌性脊柱炎的临床疗效观察

Retrospective analysis of the clinical efficacy of anterior or posterior combined operation in treatment of cervical spine Brucella spondylitis

摘要:

目的 探讨颈椎布鲁杆菌性脊柱炎的手术选择及治疗效果。方法 回顾性分析2007年8月—2017年8月河北北方学院附属第一医院标准化抗布鲁杆菌性脊柱炎药物治疗前提下行一期前路或者前后路联合手术治疗的42例颈椎布鲁杆菌性脊柱炎患者的临床资料。其中累及颈椎3个相邻椎体7例，2个相邻椎体23例，单椎体12例，合并有颈椎管狭窄患者5例，均存在不同程度的神经功能损害。进行实验室检查包括C反应蛋白（CRP）、血沉（ESR）、虎红平板凝集试验、血清试管凝集试验。以美国脊髓损伤协会（ASIA）分级、日本骨科学会（JOA）、颈部疼痛视觉模拟VAS评分判定临床效果。术前应用磺胺甲基异恶唑、强力霉素和利福平治疗14 d以上，待ESR呈下降趋势或持续处于某一数值时进行手术治疗。根据脊髓神经受压和病灶累及椎体的情况选择颈椎前路或前后路联合入路进行手术。手术后继续进行标准化抗布鲁杆菌病药物治疗。结果 患者未出现病情加重情况，末次随访优良率为100%。术后12个月复查颈椎X射线片及MRI未发现复发。术后末次随访颈部VAS评分较术前降低（P <0.05）；术后末次随访JOA评分较术前升高（P <0.05）；术后末次随访ASIA分级中D级7例，E级35例，神经功能恢复较术前明显（P <0.05）。结论 在术前规范化药物治疗前提下，根据感染累及椎体及椎管的情况采取一期病灶清除联合植骨融合内固定手术，能够极大减少患者的痛苦及致残的概率，有效地控制病情进展，恢复颈椎稳定性，挽救神经功能，临床疗效值得肯定，术后继续标准化药物治疗是防止布鲁杆菌性脊柱炎复发的关键。

Abstract:

Objective To explore the surgical selection and treatment effect of cervical brucellar spondylitis.Methods The data of 42 patients with cervical brucellar spondylitis who underwent one stage anterior or anterior-posterior approach surgery with the premise of standardized anti-brucellar spondylitis drug treatment in the First Affiliated Hospital of Hebei North University were selected. Among them, 7 cases involved 3 adjacent vertebrae, 23 cases involved 2 adjacent vertebrae, and 12 cases involved single vertebrae. In addition, there were 5 patients with cervical spinal stenosis. All patients suffered from neurological impairment with different degrees. The general clinical conditions were observed before operation. The laboratory tests included C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Brucellosis rose brucellosis plane test: tiger red plate agglutination test (RBPT), serum agglutination test (SAT); X-ray film and MRI were used as observation indexes for clinical efficacy evaluation and imaging; neurological function was assessed using the American Spinal Cord Injury Association (ASIA) classification, and the Japanese Orthopaedic Association (JOA) and the Visual Analog Scale (VAS) score were used as evaluation for neck pain. The patients were treated with sulfamethoxazole, doxycycline, and rifampicin for more than 14 days before operation, and the patients were operated when ESR showed a downward trend or remained at a certain value, surgery should be carried out. According to the compression of the spinal nerve and the involvement of the focus in the vertebral body, anterior or anterior-posterior approach surgery was selected for the operation. Standardized anti-brucellar spondylitis drug treatment was continued after operation.Results There was no aggravation for the disease of patients, and the excellent and good rate of the last follow-up reached 100%. No recurrence was found in the X-ray and MRI of cervical vertebrae at 12 months after operation. The VAS score at the last postoperative follow-up was lower than the VAS score before the operation (P < 0.05). The JOA score at the last postoperative follow-up were increased compared with the JOA score before the operation (P <0.05). At the last follow-up after operation, there were 7 cases with grade D and 35 cases with grade E according to the classification of American Spinal Cord Injury Association (ASIA). Compared with that before operation, the neurological function recovered obviously (P < 0.05).Conclusion With the premise of standardized drug treatment before operation, one-stage focus debridement combined with bone graft fusion and internal fixation can greatly reduce the pain and disability rate of patients, effectively control the progress of the disease, restore the stability of the cervical vertebra, rescue the nerve function, and the clinical effect is worthy of affirmation. The continuous standardized drug treatment after operation is key to prevent the recurrence of brucellar spondylitis.