微创侧入路腰椎椎间融合联合后路内固定治疗腰椎间隙感染

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摘要目的微创极外侧入路腰椎椎间融合(extreme lateral interbody fusion，XLIF)联合后路经皮椎弓根螺钉内固定治疗腰椎间隙感染的临床疗效分析。方法回顾本院2012年1月至2018年12月施行XLIF联合后路经皮椎弓根螺钉内固定治疗成人化脓性腰椎间隙感染20例23个节段，其中男13例，女7例，年龄18~67岁，平均54.9岁。统计手术时间、出血量、卧床时间、临床症状改善及并发症，测量相关影像学指标以评估矢状位平衡改善、局部后凸畸形纠正、间接减压指标特点以及骨融合情况。结果本组患者均获随访，随访11~56个月，平均18.9个月。单节段平均手术时间(279.6±73.9)min，出血量(241.3±70.1)mL，术后平均卧床(4.4±2.8)d。末次随访腰部VAS评分(0.65±0.49)分、ODI评分(9.30±1.63)%，均显著低于术前的(6.60±1.05)分和(77.65±9.41)%(P＜0.05)。腰椎前凸角增加6.12°(14.7%)(P＜0.05)，腰椎矢状位平衡得到有效改善；局部后凸Cobb角减少1.99°(－21.6%)(P＜0.05)，后凸畸形得到纠正。术后椎间隙高度、椎间孔高度、椎间孔面积、椎管面积、椎管中央矢状径等间接减压指标较术前均显著提高(P＜0.05)。植骨均获融合，术后临床恢复良好，无感染复发需再次手术病例。结论对于选择合适的化脓性腰椎间隙感染病例，微创XLIF联合后路经皮椎弓根螺钉内固定术病灶清除彻底、脊柱稳定性好，术后临床症状和影像学指标均显著改善，是一种微创、安全、有效的治疗成人腰椎间隙感染手术方式。

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关键词 ：腰椎间隙感染, 微创, 极外侧入路腰椎椎间融合, 经皮椎弓根螺钉内固定

Abstract：Objective To evaluate effect of minimally invasive extreme lateral interbody fusion (XLIF) combined with posterior percutaneous pedicle screw fixation in the treatment of pyogenic lumbar intervertebral infection.Methods 20 cases with pyogenic lumbar intervertebral space infection who underwent surgery with XLIFtechnique and posterior percutaneous pedicle screw fixation were included in the study from January 2012 to December 2018 in our hospital.Their data about operative time，estimate blood loss，length of stay，bone fusion state，kyphosis and sagittal balance correction，clinical and radiographic characteristics were retrospectively collected and analyzed.Results Twenty consecutive cases (were reviewed，with mean age of 54.9 years old (18~67)and 18.9 months (11~56)follow-up duration.There were 23 operative levels analyzed in this study.The mean operative time was (279.6±73.9)minutes per segment，and estimate blood loss (241.3±70.1)mL，with mean postoperative length of stay (4.4±2.8)days.At the final follow-up，11 to 56 months postoperatively，back pain visual analogue scores (VAS) and Oswestry disability index (ODI) were significantly reduced (9.30±1.63% vs 0.65±0.49 and 77.65±9.41% vs 6.60±1.05 respectively) compared to preoperative values(P＜0.05).Lumbar lordosis increased 6.12° (14.7%) (P＜0.05)and segmental kyphosis reduced 1.99° (－21.6%) (P＜0.05) postoperatively which demonstrated sagittal balance maintained and kyphotic deformity corrected effectively.Moreover，indirect decompression indexes including intervertebral space height，foraminal height，foraminal area，spinal canal cross sectional area (CSA) and central sagittal diameter were significantly improved postoperatively(P＜0.05).Bone fusions were verified radiographically in all cases at the final follow-up.All the patients showed neurological recovery and no reoperation was needed and no recurrence of infection.Conclusion Minimally invasive XLIF technique combined with posterior percutaneous pedicle screw fixation showed merits of debridement completely，keeping spine stability effectively and improved clinical and radiographic parameters in proper selected pyogenic lumbar intervertebral infection cases.

Key words： lumbar intervertebral space infection minimally invasive surgery extreme lateral interbody fusion percutaneous pedicle screw fixation

通讯作者: 何清义

作者简介: 杨正伟(1987－ )，男，研究生在读，陆军军医大学第一附属西南医院骨科，400038。

引用本文:

杨正伟，卢宏伟，胡峻贤，罗飞，许建中，何清义 *. 微创侧入路腰椎椎间融合联合后路内固定治疗腰椎间隙感染[J]. 实用骨科杂志, 2019, 25(6): 493-499.
Yang Zhengwei，Lu Hongwei，Hu Junxian，et al. Clinical Effect of Extreme Lateral Interbody Fusion (XLIF) Combined with Posterior Percutaneous Pedicle Screw Fixation in the Treatment of Lumbar Intervertebral Infection. sygkzz, 2019, 25(6): 493-499.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I6/493

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