| 经皮内镜下病灶清除灌洗引流术治疗单节段化脓性脊柱炎的早期效果 |
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Received:December 20, 2017
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| 作者 | Author | 单位 | Unit | E-Mail |
| 郑琦 |
ZHENG Qi |
杭州市红十字会医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou 310003, Zhejiang, China |
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| 金阳辉 |
JIN Yang-hui |
杭州市红十字会医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou 310003, Zhejiang, China |
15224065775@163.com |
| 应小樟 |
YING Xiao-zhang |
杭州市红十字会医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou 310003, Zhejiang, China |
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| 汪翼凡 |
WANG Yi-fan |
杭州市红十字会医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou 310003, Zhejiang, China |
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| 石仕元 |
SHI Shi-yuan |
杭州市红十字会医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou 310003, Zhejiang, China |
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| 朱博 |
ZHU Bo |
杭州市红十字会医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou 310003, Zhejiang, China |
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| 期刊信息：《中国骨伤》2018年31卷，第4期，第361-367页 |
| DOI：10.3969/j.issn.1003-0034.2018.04.012 |
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目的：评价经皮内镜下病灶清除灌洗引流术治疗化脓性脊柱炎的临床应用价值。
方法：回顾分析2014年6月至2015年12月收治的18例单节段化脓性脊柱炎患者的资料，其中男11例，女7例；年龄46~75（58.89±9.46）岁。术后根据诊断及药敏结果给予抗感染治疗。术后随访时间12~24（15.50±3.45）个月，监测术前、术后相关时间节点的红细胞沉降率及C-反应蛋白评估疾病控制情况。采用疼痛视觉模拟评分（visual analogue scale，VAS）评价患者疼痛症状的缓解情况。采用神经功能ASIA分级评价患者神经功能恢复情况。采用Kirkaldy-Willis功能评分标准评价患者术后临床疗效。通过影像学资料评价患者脊柱稳定性及感染复发情况。
结果：所有病例顺利完成手术，术后均无血肿、神经损伤、感染、脑脊液漏、置管部位窦道形成、混合感染等并发症发生。术后细菌学报告培养阳性12例，无细菌生长6例，13例病理明确其诊断。术后2周、3个月、末次随访的ESR、CRP及VAS评分与术前比较，均明显改善（P<0.05）。术后1周~3个月患者临床症状明显改善。按Kirkaldy-Willis功能评分，优14例，良3例，可1例。末次随访时神经功能ASIA均恢复正常，Cobb角丢失度为（1.11±1.18）°，与术前比较差异无统计学意义（P>0.05）。随访期间均未出现感染复发。
结论：经皮内镜下病灶清除灌洗引流术是治疗为化脓性脊柱炎微创、有效、安全的手术方式，该技术为化脓性脊柱炎的治疗提供了一种新的选择方法。 |
| [关键词]:化脓性脊柱炎 感染控制 外科手术,微创性 治疗结果 |
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| Eearly clinical effects of percutaneous endoscopic focal cleaning and drainage in the treatment of single-level suppurative spondylitis |
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Abstract:
Objective: To evaluate the clinical value of percutaneous endoscopic focal cleaning and drainage in the treatment of single-level suppurative spondylitis.
Methods: The clinical data of 18 patients with single-level suppurative spondylitis treated by percutaneous endoscopic focal cleaning and drainage from June 2014 to December 2015 were retrospectively analyzed. There were 11 males and 7 females,aged from 46 to 75 years old with an average of (58.89±9.46) years. According to the patient's diagnosis and drug sensitivity results to anti-infection therapy after operation. All the patients were followed up for 12 to 24 months with an average of(15.50±3.45) months. Disease control status was evaluated by laboratory examination of erythrocyte sedimentation rate (ESR),C-reactive protein (CRP) before and after operation. Relief of pain was evaluated using visual analogue scale(VAS). Nerve function was assessed by ASIA classification. Clinical effects were evaluated by Kirkaldy-Willis standard. Spinal stability and recurrence of infection were observed by imaging data.
Results: All the operations were successful,and no complication as hematoma,nerve injury,infection,cerebrospinal fluid leakage,sinus formation at the site of tube placement,or mixed infection were found. Postoperative bacteriological report was positive in 12 cases,while 6 cases showed no bacterial growth,and the infection status in 13 cases were confirmed by pathological examination. ESR,CRP,VAS at 2 weeks,3 months after surgery and at the final follow-up were obviously improved(P<0.05). Clinical symptoms were improved significantly at 1 week to 3 months after operation. According to Kirkaldy-Willis standard to evaluate the clinical effect,14 cases obtained excellent results,3 good,and 1 fair. Nerve function recovery was based on ASIA grading at the final follow-up. The lost Cobb angles were (1.11±1.18)° on average,with no statistically significant difference before and after operation (P>0.05). During the follow-up,no recurrent infection has occurred.
Cunclusion: Percutaneous endoscopic focal cleaning and drainage is a minimally invasive,effective and safe surgical method,which serves as a new choice for surgical treatment of suppurative spondylitis. |
| KEYWORDS:Suppurative spondylitis Infection control Surgical procedures,minimally invasive Treatment outcome |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 郑琦,金阳辉,应小樟,汪翼凡,石仕元,朱博.经皮内镜下病灶清除灌洗引流术治疗单节段化脓性脊柱炎的早期效果[J].中国骨伤,2018,31(4):361~367 |
| 英文格式: | ZHENG Qi,JIN Yang-hui,YING Xiao-zhang,WANG Yi-fan,SHI Shi-yuan,ZHU Bo.Eearly clinical effects of percutaneous endoscopic focal cleaning and drainage in the treatment of single-level suppurative spondylitis[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(4):361~367 |
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