文献类型：期刊文献

中文题名：布氏菌性脊柱炎后路病灶清除植骨融合内固定术后辅助灌注冲洗的临床疗效

英文题名：Clinical effect of closed-suction irrigation in patients with brucellosis spondylitis after one-stage posterior debridement and bone grafting fusion with internal fixation

作者：申林明[1];朱海[1];王正平[1];李依奇[1];刘贝[1];温发延[1,2];柳永明[2]

第一作者：申林明

机构：[1]甘肃中医药大学研究生院,兰州市730030;[2]甘肃省中医院脊柱骨四科,兰州市730050

第一机构：甘肃中医药大学党委研究生工作部、研究生院

年份：2025

卷号：35

期号：7

起止页码：722

中文期刊名：中国脊柱脊髓杂志

外文期刊名：Chinese Journal of Spine and Spinal Cord

收录：;北大核心:【北大核心2023】；

基金：甘肃省卫生健康行业项目(GSWSKY2022-42);兰州市科技计划项目(2024-4-40)。

语种：中文

中文关键词：布氏杆菌性脊柱炎;灌注冲洗;一期后路病灶清除;植骨融合术;随机对照

外文关键词：Brucellosis spondylitis;Closed-suction irrigation;One-stage posterior debridement;Bone graft fusion;Randomized controlled trial

摘要：目的:观察布氏菌性脊柱炎(brucellosis spondylitis,BS)一期后路病灶清除植骨融合内固定术后灌注冲洗的作用。方法:将2022年8月~2023年12月行一期后路病灶清除植骨融合内固定术治疗的30例BS患者随机分为对照组和观察组(各15例)。对照组男10例,女5例,年龄44.1±7.8岁;观察组男11例,女4例,年龄42.1±6.6岁。对照组患者给予术后常规治疗,观察组患者在对照组的基础上进行庆大霉素灌注冲洗治疗。术后第1天起,使用庆大霉素80mg+生理盐水3000mL持续清洗创面,连续冲洗2周。观察两组患者术前和术后第1天、1周、2周、3个月、6个月及术后1年的红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)。比较两组术前及术后1年的影像学资料,包括腰椎前凸角(lumbar lordosis,LL)和椎间隙高度(disc height,DH),术后1年根据Suk分级评价椎间融合情况,并记录术后并发症。结果:术后第1天,两组患者的ESR和CRP水平较术前均显著升高(P<0.05)。术后1周,两组患者的CRP水平较术前显著降低(P<0.05)。术后2周,观察组患者的ESR低于术前水平(P<0.05),而对照组患者在术后3个月时低于术前水平(P<0.05)。随时间推移,两组患者的VAS评分、ODI较术前均显著降低(P<0.05)。观察组的ESR、CRP、VAS评分、ODI在术后1周、术后2周及术后3个月时显著低于对照组(P<0.05)。术后6个月时,两组患者的ESR、CRP指标均恢复正常水平。术后1年,两组患者的LL和DH较术前均增加(P<0.05);对照组患者的总体融合率为100%,观察组为93.33%。两组患者融合率比较,差异无统计学意义(P>0.05)。研究期间两组患者均未出现术后并发症。结论:BS一期后路病灶清除植骨融合内固定术后行灌注冲洗可辅助降低患者的炎症标志物,缓解腰部疼痛,改善腰椎功能。
Objectives:The purpose of this study was to observe the effect of closed-suction irrigation in patients with brucellosis spondylitis(BS)after one-stage posterior debridement and bone graft fusion with internal fixation.Methods:30 patients with BS after one-stage posterior debridement and bone graft fusion with internal fixation,admitted between August 2022 and December 2023,were randomly divided into control group(15 cases)and observation group(15 cases).In the control group,there were 10 males and 5 females,with an age of 44.1±7.8 years;In the observation group,there were 11 males and 4 females,with an age of 42.1±6.6 years.The control group received conventional treatment after operation,and the observation group received gentamicin closed-suction irrigation treatment on the basis of the control group.From the first day after surgery,gentamicin 80mg+normal saline 3000mL was used to continuously irrigate the wound for 2 weeks.The erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),visual analogue scale(VAS),and Oswestry disability index(ODI)were observed before operaion,and on the 1st day after operation,at 1 week,2 weeks,3 months,6 months,and 1 year after operation.The imaging data of the two groups before operation and at 1 year after operation were compared,including lumbar lordosis(LL)and disc height(DH).At 1 year after operation,the fusion rate was evaluated according to Suk classification.The postoperative complications were recorded.Results:On the first day after operation,the levels of ESR and CRP in both groups were significantly higher than those before operation(P<0.05).At 1 week after operation,the CRP level of patients in the two groups was significantly lower than that before operation(P<0.05).At 2 weeks after operation,the ESR of the patients in the observation group was lower than that before operation(P<0.05),while the ESR in the control group was lower than that before operation at 3 months after operation(P<0.05).With the passage of time,the VAS score and ODI of the two groups were significantly lower than those before operation(P<0.05).The ESR,CRP,VAS and ODI in the observation group were significantly lower than those in the control group at 1 week,2 weeks and 3 months after operation(P<0.05).At 6 months after operation,the ESR and CRP levels of patients in both groups returned to normal.One year after operation,both LL and DH in the two groups of patients increased compared with those before operation(P<0.05).The overall fusion rate was 100%in the control group and 93.33% in the experimental group(P>0.05).No postoperative complications occurred during the study in either group.Conclusions:Closed-suction irrigation after one-stage posterior debridement and bone-graft fusion with internal fixation for the patients with BS can help to reduce the inflammatory markers,relieve back pain and improve lumbar function.