一期前路手术治疗颈椎布病脊柱炎

Single-Stage Anterior Approach for the Treatment of Cervical Brucellar Spondylitis

摘要: 目的：探讨一期前路手术治疗颈椎布病脊柱炎的临床医学疗效。方法：从2016年10月至2019年6月，对15例颈椎布病脊柱炎患者进行回顾性分析。其中男6例，女9例，年龄介于46~62岁之间。所有患者均有颈部疼痛，部分患者伴有不同程度感觉运动功能障碍，所有患者均接受一期前路病灶清除植骨融合内固定手术治疗。手术后，选择疼痛视觉模拟评分(Visual Analogue Scales, VAS)、颈椎功能障碍指数量表(Neck Disability Index, NDI)和日本骨科学会评分(Japanese Orthopaedic Association, JOA)进行临床医学疗效评估。结果：15例患者术后颈部疼痛明显减轻，感觉运动功能得到了明显改善。随访12~36个月，平均(23.6 ± 7.1)个月，末次VAS评分、NDI指数和JOA评分与术前比较，差异有统计学意义(P < 0.05)。在末次随访中，所有患者均获得骨性融合，无内固定松动、移位等情况发生，未出现复发。结论：颈椎布病脊柱炎在药物治疗的基础上，行一期前路手术治疗可以有效清除病灶组织，消除颈部疼痛，恢复感觉运动功能，临床医学效果令人满意。

Abstract: Objectives: To discuss the clinical effect of single-stage anterior approach for the treatment of cervical brucellar spondylitis. Methods: This was a retrospective review on 15 patients with cervical brucellosis spondylitis who were treated by single-stage anterior approach surgery from October 2016 to June 2019. There were 6 males and 9 females, aged from 46~62 years. All of the patients had neck pain with varying degrees of nerves functional impairment and were treated by one-stage anterior debridement bone graft fusion and internal fixation. The Visual Analogue Scales (VAS), Neck Disability Index (NDI) and Japanese Orthopedics Association Score (JOA) are used for clinical efficacy evaluation. Results: The postoperative neck pain and limb sensorimotor function of 15 patients were significantly improved. The follow-up was 12~36 months, with an average 23.6 ± 7.1 months. The final VAS score, NDI index, and JOA score were significantly different from those before surgery (P < 0.05). In addition, all patients had bone graft fusion at the last follow-up without complications such as recurrence, loosening of internal fixation, and displacement. Conclusions: The single-stage anterior approach for the treatment of cervical brucellar spondylitis provides pain relief, helps in providing cervical spine stability, and restores nerve function to obtain satisfactory clinical results.