CLINICAL EVALUATION OF ONE-STAGE RADICAL DEBRIDEMENT COMBINED WITH POSTERIOR PEDICLE INTERNAL FIXATION FOR BRUCELLAR SPONDYLITIS OF THE THORACIC AND LUMBAR VERTEBRAE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Xinming ¹ , ZHANG Lei ² , ZHANG Ying ¹ , WANG Yaoyi ³ , MENG Xianyong ¹ , YIN Yanlin ¹ , SHI Wei ¹ , ZHANG Junwei ¹ , ZHANG Peinan ¹ , ZHAO Yusen ³

1Department of Orthopaedics, the First Affiliated Hospital of Hebei North University, Zhangjiakou Hebei, 075000, P.R.China;;
2Department of Neurosurgery, the 4th Hospital of Hebei Medical University;;
3Department of Anatomy and Histology and Embryology, Hebei North University.;

Corresponding?author：

Keywords：

布魯桿菌病性脊椎炎; 胸腰椎; 病灶清除術; 后路椎弓根內固定

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【摘要】目的 探討布魯桿菌病性脊椎炎有效的外科治療方法及臨床效果。方法 2002年1月－2010年10月，對78例具有手術指征的胸腰椎布魯桿菌病性脊椎炎患者采用一期病灶清除聯合后路椎弓根內固定治療。男42例，女36例；年齡24～65歲，平均45歲。病程8～29個月，平均12個月。2個椎體受累70例，3個椎體受累8例。均合并不同程度神經功能損傷。術后隨訪行疼痛視覺模擬評分（VAS）、神經功能Frankel分級、臨床療效評價以及X線片、MRI影像學觀察。結果術后78例均獲隨訪，隨訪時間12～30個月，平均26個月。無竇道形成及復發。術前及術后1、3、6、12個月VAS評分分別為（9.2 ± 0.6）、（2.4 ± 0.3）、（1.0 ± 0.2）、（0.5 ± 0.4）及0分，術后各時間點均較術前顯著改善（P lt; 0.05）。術后各時間點神經功能Frankel分級均較術前顯著改善，差異均有統計學意義（P lt; 0.05），其中C、D級改善最為顯著。臨床療效評價：術后12個月內均無加重患者；隨時間推移，改善及無變化患者逐漸轉向痊愈，術后12個月改善率和痊愈率分別為100%和91.03%。影像學評價：術前及術后1、3、6、12個月影像學盲測評價指標評分分別為（0.17 ± 0.03）、（4.11 ± 0.09）、（4.68 ± 0.04）、（4.92 ± 0.08）及5分，術后各時間點均較術前顯著改善（P lt; 0.05）。結論一期病灶清除聯合后路椎弓根內固定治療胸腰椎布魯桿菌病性脊椎炎，在解除疼痛、穩定脊柱、恢復神經功能及早期康復方面均有明顯優勢。

Citation： YANG Xinming,ZHANG Lei,ZHANG Ying,WANG Yaoyi,MENG Xianyong,YIN Yanlin,SHI Wei,ZHANG Junwei,ZHANG Peinan,ZHAO Yusen. CLINICAL EVALUATION OF ONE-STAGE RADICAL DEBRIDEMENT COMBINED WITH POSTERIOR PEDICLE INTERNAL FIXATION FOR BRUCELLAR SPONDYLITIS OF THE THORACIC AND LUMBAR VERTEBRAE. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(3): 266-271. doi: Copy

1.	1 楊新明, 石蔚, 杜雅坤, 等. 布魯桿菌性脊柱炎臨床療效觀察. 中國地方病學雜志, 2008, 27(6): 699-703. 2 楊新明, 石蔚, 陰彥林, 等. 布氏桿菌性脊柱炎流行病學調查和臨床藥物治療的相關研究. 實用醫學雜志, 2008, 24(9): 1632-1634.
2.	楊新明, 石蔚, 杜雅坤, 等. 布魯桿菌病性脊柱炎的臨床影像學表現及外科治療. 中華骨科雜志, 2008, 28(1): 35-40.
3.	楊新明, 張磊, 劉肅, 等. 布魯桿菌病性脊柱炎//楊新明, 石蔚. 脊柱疾病. 北京: 科學技術文獻出版社, 2011: 271-275.
4.	Saltoglu N, Tasova Y, Inal AS, et al. Efficacy of rifampicin plus doxycycline versus rifampicin plus quinolone in the treatment of brucellosis. Saudi Med J, 2002, 23(8): 921-924.
5.	Turgut M, Turgut AT, Ko?ar U. Spinal brucellosis: Turkish experience based on 452 cases published during the last century. Acta Neurochir (Wien), 2006, 148(10): 1033-1044.
6.	Ioannou S, Karadima D, Pneumaticos S, et al. Efficacy of prolonged antimicrobial chemotherapy for brucellar spondylodiscitis. Clin Microbiol Infect, 2011, 17(5): 756-762.
7.	Raptopoulou A, Karantanas AH, Poumboulidis K, et al. Brucellar spondylodiscitis: noncontiguous multifocal involvement of the cervical, thoracic, and lumbar spine. Clin Imaging, 2006, 30(3): 214-217.
8.	Namiduru M, Karaoglan I, Gursoy S, et al. Brucellosis of the spine: evaluation of the clinical, laboratory, and radiological findings of 14 patients. Rheumatol Int, 2004, 24(3): 125-129.
9.	German V, Papadopoulos N, Diakalis C, et al. Paravertebral abscess and neurological deficits in cervical brucellar spondylitis. East Mediterr Health J, 2010, 16(4): 448-450.
10.	Lee C, Dorcil J, Radomisli TE. Nonunion of the spine: a review. Clin Orthop Relat Res, 2004, (419): 71-75.
11.	Pina MA, Modrego PJ, Uroz JJ, et al. Brucellar spinal epidural abscess of cervical location: report of four cases. Eur Neurol, 2001, 45(4): 249-253.
12.	Ledermann HP, Schweitzer ME, Morrison WB, et al. MR imaging findings in spinal infections: rules or myths? Radiology, 2003, 228(2): 506-514.
13.	Yilmaz MH, Mete B, Kantarci F, et al. Tuberculous, brucellar and pyogenic spondylitis: comparison of magnetic resonance imaging findings and assessment of its value. South Med J, 2007, 100(6): 613-614.
14.	Tali ET. Spinal infenctions. Eur J Radiol, 2004, 50(2): 120-133.
15.	Solis Garcia del Pozo J, Vives Soto M, Solera J. Vertebral osteomyelitis: long-term disability assessment and prognostic factors. J Infect, 2007, 54(2): 129-134.
16.	Katonis P, Tzermiadianos M, Gikas A, et al. Surgical treatment of spinal brucellosis. Clin Orthop Relat Res, 2006, (444): 66-72.
17.	Ates O, Cayli SR, Koççak A, et al. Spinal epidural abscess caused by brucellosis. Neurol Med Chir (Tokyo), 2005, 45(1): 66-70.
18.	王自立. 對徹底治愈脊柱結核病灶及其相關問題的管見. 中國脊柱脊髓雜志, 2008, 18(8): 568-570.
19.	Ozdemir HM, Us AK, O?ün T. The role of anterior spinal instrumentation and allograft fibula for the treatment of pott diease. Spine (Phila Pa 1976), 2003, 28(5): 474-479.
20.	Dai LY, Jiang LS, Wang W, et al. Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine (Phila Pa 1976), 2005, 30(20): 2342-2349.
21.	Fukuta S, Miyamoto K, Masuda T, et al. Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine (Phila Pa 1976), 2003, 28(15): E302-308.
22.	Bouaziz MC, Bougamra I, Kaffel D, et al. Noncontiguous multifocal spondylitis: an exceptional presentation of spinal brucellosis. Tunis Med, 2010, 88(4): 280-284.

1. 1 楊新明, 石蔚, 杜雅坤, 等. 布魯桿菌性脊柱炎臨床療效觀察. 中國地方病學雜志, 2008, 27(6): 699-703. 2 楊新明, 石蔚, 陰彥林, 等. 布氏桿菌性脊柱炎流行病學調查和臨床藥物治療的相關研究. 實用醫學雜志, 2008, 24(9): 1632-1634.
2. 楊新明, 石蔚, 杜雅坤, 等. 布魯桿菌病性脊柱炎的臨床影像學表現及外科治療. 中華骨科雜志, 2008, 28(1): 35-40.
3. 楊新明, 張磊, 劉肅, 等. 布魯桿菌病性脊柱炎//楊新明, 石蔚. 脊柱疾病. 北京: 科學技術文獻出版社, 2011: 271-275.
4. Saltoglu N, Tasova Y, Inal AS, et al. Efficacy of rifampicin plus doxycycline versus rifampicin plus quinolone in the treatment of brucellosis. Saudi Med J, 2002, 23(8): 921-924.
5. Turgut M, Turgut AT, Ko?ar U. Spinal brucellosis: Turkish experience based on 452 cases published during the last century. Acta Neurochir (Wien), 2006, 148(10): 1033-1044.
6. Ioannou S, Karadima D, Pneumaticos S, et al. Efficacy of prolonged antimicrobial chemotherapy for brucellar spondylodiscitis. Clin Microbiol Infect, 2011, 17(5): 756-762.
7. Raptopoulou A, Karantanas AH, Poumboulidis K, et al. Brucellar spondylodiscitis: noncontiguous multifocal involvement of the cervical, thoracic, and lumbar spine. Clin Imaging, 2006, 30(3): 214-217.
8. Namiduru M, Karaoglan I, Gursoy S, et al. Brucellosis of the spine: evaluation of the clinical, laboratory, and radiological findings of 14 patients. Rheumatol Int, 2004, 24(3): 125-129.
9. German V, Papadopoulos N, Diakalis C, et al. Paravertebral abscess and neurological deficits in cervical brucellar spondylitis. East Mediterr Health J, 2010, 16(4): 448-450.
10. Lee C, Dorcil J, Radomisli TE. Nonunion of the spine: a review. Clin Orthop Relat Res, 2004, (419): 71-75.
11. Pina MA, Modrego PJ, Uroz JJ, et al. Brucellar spinal epidural abscess of cervical location: report of four cases. Eur Neurol, 2001, 45(4): 249-253.
12. Ledermann HP, Schweitzer ME, Morrison WB, et al. MR imaging findings in spinal infections: rules or myths? Radiology, 2003, 228(2): 506-514.
13. Yilmaz MH, Mete B, Kantarci F, et al. Tuberculous, brucellar and pyogenic spondylitis: comparison of magnetic resonance imaging findings and assessment of its value. South Med J, 2007, 100(6): 613-614.
14. Tali ET. Spinal infenctions. Eur J Radiol, 2004, 50(2): 120-133.
15. Solis Garcia del Pozo J, Vives Soto M, Solera J. Vertebral osteomyelitis: long-term disability assessment and prognostic factors. J Infect, 2007, 54(2): 129-134.
16. Katonis P, Tzermiadianos M, Gikas A, et al. Surgical treatment of spinal brucellosis. Clin Orthop Relat Res, 2006, (444): 66-72.
17. Ates O, Cayli SR, Koççak A, et al. Spinal epidural abscess caused by brucellosis. Neurol Med Chir (Tokyo), 2005, 45(1): 66-70.
18. 王自立. 對徹底治愈脊柱結核病灶及其相關問題的管見. 中國脊柱脊髓雜志, 2008, 18(8): 568-570.
19. Ozdemir HM, Us AK, O?ün T. The role of anterior spinal instrumentation and allograft fibula for the treatment of pott diease. Spine (Phila Pa 1976), 2003, 28(5): 474-479.
20. Dai LY, Jiang LS, Wang W, et al. Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine (Phila Pa 1976), 2005, 30(20): 2342-2349.
21. Fukuta S, Miyamoto K, Masuda T, et al. Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine (Phila Pa 1976), 2003, 28(15): E302-308.
22. Bouaziz MC, Bougamra I, Kaffel D, et al. Noncontiguous multifocal spondylitis: an exceptional presentation of spinal brucellosis. Tunis Med, 2010, 88(4): 280-284.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL EVALUATION OF ONE-STAGE RADICAL DEBRIDEMENT COMBINED WITH POSTERIOR PEDICLE INTERNAL FIXATION FOR BRUCELLAR SPONDYLITIS OF THE THORACIC AND LUMBAR VERTEBRAE

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