单侧双通道内镜技术在腰椎布鲁菌病脊柱炎治疗中的应用研究

doi:10.12114/j.issn.1007-9572.2022.0714

摘要/Abstract

摘要： 背景单侧双通道内镜（UBE）技术是一种新兴的脊柱微创手术技术，近年来已被用于治疗各种退行性脊柱疾病。然而，尚未有相关文献报道该技术治疗腰椎布鲁菌病脊柱炎（LBS）。目的探讨UBE技术治疗LBS的有效性及可行性。方法选取2020年1月至2021年6月新疆医科大学第一附属医院骨科收治的LBS接受UBE技术治疗的患者13例。记录手术时间、可估计失血量及并发症发生情况。分析红细胞沉降率（ESR）、C反应蛋白（CRP）、腰背部和腿部视觉模拟评分（VAS）、日本骨科协会（JOA）评分、Oswestry残疾指数（ODI）、美国脊髓损伤协会（ASIA）神经系统分型和前凸角等临床结果。所有患者术后1年随访时采用改良Macnab标准进行评估。采用Bridwell分级标准评估椎间植骨融合情况。结果 13例LBS患者手术时间145~210 min，平均（177.31±19.54）min；可估计失血量120~290 ml，平均（176.15±43.79）ml；共发生2例并发症，发生率为2/13。术后3个月随访，ESR和CRP水平恢复正常。术后各随访时间点腰背部和腿部VAS、JOA评分及ODI均较术前明显改善，差异有统计学意义（P<0.05）。术后1年随访时改良Macnab标准评价示：优10例、良2例、可1例、差0例，优良率为12/13。前凸角由术前（47.18°±6.88°）降至出院前（40.83°±6.71°），术后1年随访时无明显角度丢失。所有患者术后1年随访时获得骨性融合，其中12例融合等级为Ⅰ级、1例为Ⅱ级，融合率为12/13。结论 UBE技术是治疗LBS的一种有效、安全、可行的手术方式。

关键词: 布鲁杆菌病, 腰椎布鲁菌病脊柱炎, 单侧双通道内镜技术, 清创术, 椎间融合, 微创手术

Abstract:

Background

The unilateral biportal endoscopy (UBE) technique is a new minimally invasive spinal surgical technique, which has been used to treat various degenerative spinal diseases in recent years. However, there is no literature reporting this technique for the treatment of lumbar brucellosis spondylitis (LBS) .

Objective

To investigate the effectiveness and feasibility of the UBE technique in the treatment of LBS.

Methods

This study selected 13 patients with LBS who received the UBE treatment in the Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University from January 2020 to June 2021. The operative duration, the estimated blood loss and complications were recorded. Clinical outcomes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the visual analog scale (VAS) scores of low back and leg, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), American Spinal Injury Association (ASIA) neurological classification, and lordotic angle were analyzed. All patients were assessed using the modified Macnab criteria at 1-year follow-up after operation. The intervertebral bone graft fusion was evaluated using Bridwell grading criteria.

Results

The operation time was 145-210 minutes, with an average of (177.31±19.54) minutes. The estimated blood loss was 120-290 ml, with an average of (176.15±43.79) ml. There were 2 complications, with an incidence rate of 2/13. ESR and CRP levels returned to normal at the 3-month follow-up. The VAS scores of low back and leg, JOA score, and ODI were significantly improved compared to those before operation at each postoperative follow-up time point, and the differences were statistically significant (P<0.05). The modified Macnab criteria evaluation at 1-year follow-up showed that the outcomes were excellent in 10 cases, good in 2 cases, fair in 1 case, and no patient showed poor outcomes, with a rate of excellent and good was 12/13. The lordotic angle decreased from preparation (47.18°±6.88°) to predischarge (40.83°±6.71°), and there was no significant loss of angle at 1-year follow-up after operation. Bony fusion was obtained in all patients at 1-year follow-up after operation, of which 12 cases were grade Ⅰ and 1 case was grade Ⅱ, with a fusion rate of 12/13.

Conclusion

UBE technique is an effective, safe and feasible surgical procedure for treating LBS.

Key words: Brucellosis, Lumbar brucellosis spondylitis, Unilateral biportal endoscopy technique, Debridement, Interbody fusion, Minimally invasive surgery

王湘斌,隆宇斌,王翀,等. 单侧双通道内镜技术在腰椎布鲁菌病脊柱炎治疗中的应用研究[J]. 中国全科医学, 2023, 26(08): 963-971. DOI: 10.12114/j.issn.1007-9572.2022.0714.
WANG Xiangbin,LONG Yubin,WANG Chong, et al. Application of Unilateral Biportal Endoscopy Technique in the Treatment of Lumbar Brucellosis Spondylitis[J]. Chinese General Practice, 2023, 26(08): 963-971. DOI: 10.12114/j.issn.1007-9572.2022.0714.

图/表 5

图1 典型病例术前MRI结果注：A为术前MRI T2WI示：L4~5椎管层面硬膜外脓肿呈高信号；B为术前MRI横断面示：硬膜外脓肿压迫硬脊膜和神经根

Figure 1 Preoperative MRI findings of typical case

图2 男，57岁，L4~5布鲁菌病脊柱炎，行UBE下减压、清创、椎间融合联合经皮螺钉内固定术注：A和B为C臂X线机透视确认逐级扩张器和椎板解剖器汇集点位置，头端为观察通道、尾端为工作通道；C为内镜下示淡红色非干酪样炎性肉芽组织及血管增生明显；D为内镜下示钩状探针暴露、分离炎性肉芽组织；E为内镜监视下植入装满混有利福平自体骨的Cage；F为术后切口情况

Figure 2 A 57-year-old man with L4/5 brucellosis spondylitis underwent UBE decompression，debridement，interbody fusion，combined with percutaneous screw fixation

图3 典型病例术后影像学和病理检查结果注：A为侧位X线片示：内固定位置良好；B为CT矢状位示：植骨充分；C为CT横断面示：Cage位置良好；D为MRI T2WI示：椎管减压充分；E为MRI横断面示：病灶清除完全、减压充分及Cage位置良好；F为病理组织学示：非干酪样坏死肉芽肿性炎（HE染色，×400），可见大量淋巴细胞、单核细胞；G、H为术后14个月正、侧位X线片示植骨已融合、内固定位置良好

Figure 3 Postoperative Imaging and Pathological findings of typical case

表1 手术前后腰背部和腿部VAS、JOA评分及ODI的比较（±s，n=13）

Table 1 The VAS scores of low back and leg，JOA score，and ODI were compared between preoperative and postoperative

时点	腰背部VAS（分）	腿部VAS（分）	JOA评分（分）	ODI（%）
术前	5.85±1.28	3.69±2.02	13.46±3.18	55.57±10.99
术后次日	3.15±0.80^a	1.92±1.19^a	—	—
术后1个月	1.92±0.64^a	1.31±0.75^a	20.85±2.91^a	37.09±9.99^a
术后3个月	1.38±0.51^a	1.08±0.64^a	24.92±1.55^a	26.54±6.96^a
术后6个月	0.85±0.80^a	0.69±0.48^a	25.92±1.04^a	10.71±2.89^a
术后1年	0.38±0.51^a	0.31±0.48^a	27.08±0.95^a	6.14±3.38^a
F值	27.616	6.669	107.727	113.225
P值	<0.001	<0.001	<0.001	<0.001

表2 手术前后ESR和CRP比较（±s，n=13）

Table 2 Compared of ESR and CRP between preoperative and postoperative

时点	ESR（mm/1 h）	CRP（mg/L）
术前	38.69±18.98	24.51±12.98
出院前	36.23±11.39	29.56±14.32
术后1个月	24.85±9.17	13.72±6.03
术后3个月	8.77±3.72^a	5.45±1.84^a
术后6个月	8.46±2.73^a	5.13±1.75^a
术后1年	5.92±2.81^a	4.25±1.91^a
F值	15.862	19.723
P值	<0.001	<0.001

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