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：

布鲁杆菌病性脊椎炎; 胸腰椎; 病灶清除术; 后路椎弓根内固定

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【摘要】目的 探讨布鲁杆菌病性脊椎炎有效的外科治疗方法及临床效果。方法 2002年1月－2010年10月，对78例具有手术指征的胸腰椎布鲁杆菌病性脊椎炎患者采用一期病灶清除联合后路椎弓根内固定治疗。男42例，女36例；年龄24～65岁，平均45岁。病程8～29个月，平均12个月。2个椎体受累70例，3个椎体受累8例。均合并不同程度神经功能损伤。术后随访行疼痛视觉模拟评分（VAS）、神经功能Frankel分级、临床疗效评价以及X线片、MRI影像学观察。结果术后78例均获随访，随访时间12～30个月，平均26个月。无窦道形成及复发。术前及术后1、3、6、12个月VAS评分分别为（9.2 ± 0.6）、（2.4 ± 0.3）、（1.0 ± 0.2）、（0.5 ± 0.4）及0分，术后各时间点均较术前显著改善（P lt; 0.05）。术后各时间点神经功能Frankel分级均较术前显著改善，差异均有统计学意义（P lt; 0.05），其中C、D级改善最为显著。临床疗效评价：术后12个月内均无加重患者；随时间推移，改善及无变化患者逐渐转向痊愈，术后12个月改善率和痊愈率分别为100%和91.03%。影像学评价：术前及术后1、3、6、12个月影像学盲测评价指标评分分别为（0.17 ± 0.03）、（4.11 ± 0.09）、（4.68 ± 0.04）、（4.92 ± 0.08）及5分，术后各时间点均较术前显著改善（P lt; 0.05）。结论一期病灶清除联合后路椎弓根内固定治疗胸腰椎布鲁杆菌病性脊椎炎，在解除疼痛、稳定脊柱、恢复神经功能及早期康复方面均有明显优势。

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 杨新明, 石蔚, 杜雅坤, 等. 布鲁杆菌性脊柱炎临床疗效观察. 中国地方病学杂志, 2008, 27(6): 699-703. 2 杨新明, 石蔚, 阴彦林, 等. 布氏杆菌性脊柱炎流行病学调查和临床药物治疗的相关研究. 实用医学杂志, 2008, 24(9): 1632-1634.
2.	杨新明, 石蔚, 杜雅坤, 等. 布鲁杆菌病性脊柱炎的临床影像学表现及外科治疗. 中华骨科杂志, 2008, 28(1): 35-40.
3.	杨新明, 张磊, 刘肃, 等. 布鲁杆菌病性脊柱炎//杨新明, 石蔚. 脊柱疾病. 北京: 科学技术文献出版社, 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, Koşar 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. 对彻底治愈脊柱结核病灶及其相关问题的管见. 中国脊柱脊髓杂志, 2008, 18(8): 568-570.
19.	Ozdemir HM, Us AK, Oğün 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 杨新明, 石蔚, 杜雅坤, 等. 布鲁杆菌性脊柱炎临床疗效观察. 中国地方病学杂志, 2008, 27(6): 699-703. 2 杨新明, 石蔚, 阴彦林, 等. 布氏杆菌性脊柱炎流行病学调查和临床药物治疗的相关研究. 实用医学杂志, 2008, 24(9): 1632-1634.
2. 杨新明, 石蔚, 杜雅坤, 等. 布鲁杆菌病性脊柱炎的临床影像学表现及外科治疗. 中华骨科杂志, 2008, 28(1): 35-40.
3. 杨新明, 张磊, 刘肃, 等. 布鲁杆菌病性脊柱炎//杨新明, 石蔚. 脊柱疾病. 北京: 科学技术文献出版社, 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, Koşar 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. 对彻底治愈脊柱结核病灶及其相关问题的管见. 中国脊柱脊髓杂志, 2008, 18(8): 568-570.
19. Ozdemir HM, Us AK, Oğün 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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