【摘要】 目的:探讨Quadrant通道下MIS-TLIF联合膨胀式椎弓根螺钉(expandable pedicle screw,EPS)治疗老年脊柱化脓性骨髓炎(pyogenic discitis and vertebral osteomyelitis,PDVO)的可行性和临床疗效。方法:对2016年1月至2017年6月收治的11例老年脊柱化脓性骨髓炎患者的临床资料进行回顾性分析,其中男7例,女4例;年龄59～79(68.09±5.34)岁。11例患者均在全麻Quadrant通道辅助下采用MIS-TLIF技术行清创、植骨融合,联合EPS完成后路固定。记录手术时间、术中出血量、术中输血量、术后下床时间、术后并发症及随访期间的红细胞沉降率(ESR);采用视觉模拟评分(visual analogue scale,VAS)来评价临床疗效;采用影像学资料评估腰椎融合情况。结果:11例PDVO患者在Quadrant通道辅助下采用MIS-TLIF技术顺利完成了手术,清创彻底、植骨融合充分,无硬膜囊及神经根损伤等并发症的发生;手术时间(179.55±59.05) min,术中出血量(174.55±49.22) ml,术中输浓缩红细胞(109.09±97.00) ml,血浆(72.73±100.91) ml,术后下床时间(1.91±0.83) d;切口均Ⅰ期愈合,术后随访时间(19.27±11.63)个月;VAS评分术后1周为3.73±1.01,术后6个月为2.18±0.40;ESR术后6周为(19.27±2.61) mm/h(降低50%以上),术后6个月为(9.55±1.01) mm/h,均在正常范围内。随访期内所有患者达到了临床治愈标准,植骨融合时间(5.54±1.51)个月。结论:Quadrant通道下MIS-TLIF联合EPS治疗老年PDVO,实现了老年PDVO患者手术治疗的微创化,其可行性得到了验证,是治疗老年人脊柱化脓性骨髓炎的一种安全、可靠的方法。更多还原

【Abstract】 Objective:To investigate the feasibility and clinical efficacy of minimal invasive surgery-transforaminal lumbar interbody fusion(MIS-TLIF) combined with expanded pedicle screw(EPS) in the treatment of elderly patients with pyogenic discitis and vertebral osteomyelitis(PDVO).Methods:The clinical data of 11 elderly patients with pyogenic discitis and vertebral osteomyelitis treated from January 2016 to June 2017 were retrospectively analyzed including 7 males and 4 females,aged from 59 to 79 years old with an average of(68.09±5.34) years.The MIS-TLIF technique was used assisted by the Quadrant channel under general anesthesia for the debridement and bone fusion of these 11 elderly patients.The posterior fixation was performed with EPS.The operation time,intraoperative blood loss,intraoperative blood transfusion,and postoperative time of out of bed,postoperative complications and erythrocyte sedimentation rate(ESR)were recorded.Visual analogue scale(VAS) was used to evaluate the clinical effects and the imaging data were used to observe lumbar fusion.Results:All the operations were successfully performed,the debridement was thorough,bone fusion was adequate,and no complications such as dural sac and nerve root injury were found.The operation time and intraoperative blood loss was(179.55±59.05) min and(174.55±49.22)ml,respectively.Concentrated red blood cells of(109.09±97.00) ml and plasma of(72.73±100.91) ml were given during operation.The time of out of bed was(1.19±0.83) d.All the incisions obtained healing at the first stage.The average follow-up time was(19.27±11.63) months.VAS scoring at 1 week and 6 months after surgery was 3.73±1.01 and 2.18±0.40;ESR at 6 weeks after surgery was(19.27±2.61) mm/h(decreased by more than 50%),at 6 months after surgery was(9.55±1.01) mm/h,both within normal range.During the follow-up period,all patients reached the clinical cure standard,and the bone fusion time was(5.54±1.51) months.Conclusion:MIS-TLIF combined with EPS through Quadrant channel in the treatment of elderly patients with PD VO has achieved minimally invasive surgery.The feasibility of this method also has been verified and satisfactory clinical results have been achieved.It is a safe and reliable treatment for elderly patients with spinal suppurative osteomyelitis.更多还原