经皮椎间孔镜与后路手术治疗腰椎布氏杆菌性脊柱炎的疗效分析

Efficacy Analysis of Percutaneous Transforaminal Endoscopic Surgery and Posterior Surgery for the Treatment of Lumbar Brucella Spondylitis

摘要: 目的：本研究旨在比较经皮椎间孔镜病灶清除术与后路病灶清除植骨融合内固定术治疗腰椎布氏杆菌性脊柱炎的临床疗效。方法：回顾性分析2017年2月至2022年2月我院采用微创经皮椎间孔镜病灶清除术(以下简称孔镜组，12例)和传统开放后路病灶清除植骨融合内固定术(以下简称后路组，42例)的54例腰椎布氏杆菌性脊柱炎患者的临床资料，对比两组的住院时间、手术时长、切口大小、术中出血量、术后下地时间、红细胞沉降率(ESR)、C反应蛋白(CRP)、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及术后并发症等情况。结果：两组患者平均随访时间24个月(19~28个月)，症状均明显好转。孔镜组的切口长度、术中出血量和术后下地时间均较后路组显著缩短，存在显著性差异(P < 0.05)。组内比较：同组不同时间(术前与术后3月、12月、24月)的ESR、CRP、VAS和ODI比较，存在显著性差异(P < 0.05)。组间比较：非同组同一时间的ESR、CRP、VAS和ODI比较，不存在显著性差异(P > 0.05)。孔镜组术后未发生并发症，而后路组中有2例患者出现贫血。结论：孔镜组和后路组治疗腰椎布氏杆菌脊柱炎均获得满意效果，但孔镜组具有切口小、出血少、术后下地早等微创手术优势，因此经皮椎间孔镜手术是一种更好的治疗选择。

Abstract: Objective: This study aims to compare the clinical efficacy between percutaneous transforaminal endoscopic debridement and posterior debridement, bone graft fusion, and internal fixation in the treatment of lumbar brucella spondylitis. Methods: A retrospective study was conducted on the clinical data of 54 patients with lumbar brucella spondylitis from February 2017 to February 2022 in our hospital, who underwent minimally invasive percutaneous transforaminal endoscopic debridement (hereinafter referred to as the endoscopic group, 12 cases) and conventional open posterior debridement, bone graft fusion, and instrumentation (hereinafter referred to as the posterior group, 42 cases). The clinical and surgical outcomes were compared in terms of hospitalization stay, operative time, incision size, intraoperative blood loss, postoperative time to ground, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analog scale (VAS), Oswestry disability index (ODI), and postoperative complications of the 2 groups of patients. Results: Both groups were followed up for an average of 24 months (19 to 28 months), and symptoms improved significantly. Compared to the posterior group, the endoscopic group demonstrated significantly shorter incision length, intraoperative blood loss, and postoperative ambulation time with significant differences (P < 0.05). Intra group comparison: There were significant differences (P < 0.05) in ESR, CRP, VAS, and ODI within the same group at different time points (preoperative and postoperative 3 months, 12 months, 24 months). Inter group comparison: There was no significant difference (P > 0.05) in ESR, CRP, VAS, and ODI between different groups at the same time. There were no postoperative complications in endoscopic group, whereas 2 patients in posterior group developed anemia. Conclusions: Both groups have achieved satisfactory results in the treatment of lumbar brucella spondylitis. However, the endoscopic group demonstrated advantages of minimally invasive surgery such as shorter incision length, less bleeding, and early postoperative descent. Consequently, percutaneous transforaminal endoscopic debridement represents a superior treatment option.