摘要
[目的]探讨化脓性椎间盘炎的临床特点及采用后路病灶清除、椎间自体骨植骨融合、椎弓根内固定结合灌注冲洗持续引流治疗的临床疗效。[方法]回顾性分析2007年4月~2013年6月收治的22例继发、14例原发性化脓性椎间盘炎的临床资料。术前及术后第1、7、14 d及末次随访时采用视觉疼痛模拟评分（visual analogue scale,VAS）对患者腰腿疼痛情况进行评估;术前及术后第1 d,术后第3、6个月及末次随访时采用Oswestry功能障碍指数（Oswestry disability index,ODI）对疗效进行评估,并统计手术时间、术中出血量、术后并发症、住院时间等指标。[结果]所有病例手术均顺利完成,手术时间160~225 min,平均（175±20）min;术中出血量365~510 ml,平均（420±40）ml;住院时间13~16 d,平均（11±4.2）d;术前腰腿痛VAS评分（8.25±1.31）分,术后VAS评分第1 d（3.45±1.48）,第7 d（2.28±1.12）,第14 d（2.14±1.27）,末次随访时为（1.94±1.26）。VAS评分明显低于术前,差异有统计学意义（P〈0.05）,术后第7、14 d及末次随访时VAS评分明显低于术后第1 d,差异有统计学意义（P〈0.05）。术后第7、14 d及末次随访时VAS评分间差异无统计学意义（P〉0.05）。术前ODI评分（41.16±1.42）,术后ODI评分第1 d为（32.26±1.53）,术后3个月为（14.75±1.23）,6个月为（14.16±1.32）,末次随访时为（13.85±2.25）。ODI评分明显低于术前,差异有统计学意义（P〈0.05）,术后第3、6个月及末次随访时ODI评分明显低于术后第1 d,差异有统计学意义（P〈0.05）。术后第3、6个月及末次随访时ODI评分间差异无统计学意义（P〉0.05）。灌注冲洗引流8~14 d,平均（9.5±1.6）d。术后发生下肢麻木2例,硬膜破裂2例,经对症治疗后均痊愈,所有患者切口无感染或窦道形成。[结论]化脓性椎间盘炎早期正确的诊断,及时的手术治疗是获得良好疗效的基础,依据MRI特征选择合适的手术
[Objective] To investigate the treatment effect of discis by posterior deridement,transpedicular instrumentation and interbody fusion combined with continuous local irrigation drainage. [Methods] Data of 22 cases of secondary,and 14 cases of primary purulent discits from April 2007 to June 2013 were analyzed retrospectively. The waist and leg pain was evaluated with visual analogue scale（ VAS） before operation and at 1,7 and 14 days postoperatively and at the last follow-up. Oswestry disability index（ ODI） was also used to evaluate the curative effect before operation and at 1,3 and 6 months postoperatively and at the last follow- up,then statistics analysis was made on the indexes of operation time,intraoperative blood loss,postoperative complications and the length of hospital stay. [Results] All surgeries completed successful,with the operation time of 160- 225 mim [average（ 175 ± 20） mim],Amount of blood loss during operation was 365- 510 ml [ average（ 420 ± 40） ml]and the length of hospital stay was 13- 16 days [average（ 11 ± 4. 2） days]. The score of VAS before operation was（ 8. 25 ± 1. 31）,and the VAS score was（ 3. 45 ± 1. 48）,（ 2. 28 ± 1. 12）,（ 2. 14 ± 1. 27） and（ 1. 94 ± 1. 26） at 1,7 and 14 days postoperatively（ P〈0. 05）. The post- operative VAS score of all patients was lower than that of pre- operationsignificantly,and the score at each follow- up time points were lower than that of the first day postoperatively（ P〈0. 05）. There was no statistical significance among the VAS scores at 7,14 days postoperatively and at the last follow- up. The score of ODI beforeoperation was（ 41. 16 ± 1. 42）,and the VAS scores were（ 32. 26 ± 1. 53）,（ 14. 75 ± 1. 23）,（ 14. 16 ± 1. 32） and（ 13. 85 ±2. 25） at 1,3 and 6 months postoperatively and at the last follow- up（ P〈0. 05）. The post- operation ODI of all patients was lower than that of pre- operation significantly and the ODI score at each follow- up time points were lower than
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2016年第5期406-411,共6页
Orthopedic Journal of China
关键词
椎间盘炎
病灶清除
椎间融合
内固定
灌注冲洗
discits
debridement
intenrvertebral fusion
intemal fixation
irrigation and conduction
