分析及探讨腰椎布鲁杆菌性脊柱炎病椎置钉、短节段内固定的安全性及疗效。

回顾性分析2009年3月至2015年5月对符合纳入标准的行后路一期病灶清除、横突间植骨融合、病椎置钉并短节段内固定手术治疗的20例腰椎布鲁杆菌性脊柱炎患者资料，男12例，女8例，年龄20～66岁，平均41.3岁。病变节段L2-S1(均≤3个节段)。术前均行X线、CT、MRI检查，判定病变节段、病椎椎弓根和椎体骨质炎性浸润及骨破坏情况。术后影像学观察植骨融合及椎体稳定性情况，且对手术前后视觉模拟疼痛评分(VAS)、Cobb角、神经功能Frankel分级及实验室检测红细胞沉降率(ESR)、C反应蛋白(CRP)评价指标进行比较及统计学分析。

术后20例均获随访，随访时间24～48个月，平均32个月。随访期间病灶无复发，无切口感染和窦道形成，内固定牢固，无脱落、断裂及松动。所有患者布病感染中毒症状及脊柱炎症状均消失，术前Frankel分级：C级6例、D级5例、E级9例，末次随访Frankel分级：D级2例、E级18例。VAS由术前(8.85±1.62)分恢复至术后1周(3.39±0.95)分，末次随访为(0.81±0.11)分(F＝72.05，P<0.05)；术前后凸Cobb角平均为15.31°±2.42°，术后1周为4.28°±2.12°，末次随访为4.21°±1.31°(F＝214.85，P<0.05)；ESR由术前(40.25±1.51) mm/h恢复至术后1周(16.46±5.72) mm/h，末次随访为(8.47±0.62) mm/h(F＝184.49，P<0.05)；CRP由术前(71.11±7.22) mg/L恢复至术后1周(22.44±4.82) mg/L，末次随访为(5.12±0.73) mg/L(F＝265.71，P<0.05)。植骨融合时间6～11个月，平均7.4个月。

腰椎布鲁杆菌性脊柱炎在掌握好手术适应证的前提下，只要术前依据影像学资料和术中正确判断病椎感染情况，选择后路病灶清除、植骨、病椎置钉、短节段内固定手术方案对于缓解疼痛、控制感染、解除神经压迫、稳定脊柱、减少创伤、促进功能恢复是安全可靠的，并具有较好的临床效果。

To analyze and explore the safety and efficacy of pedicle screw fixation and short segment internal fixation in the treatment of lumbar brucellosis spondylitis.

A retrospective analysis from March 2009 to May 2015 according to the diagnostic criteria of posterior debridement, intertransverse fusion, disease and treatment of vertebral pedicle screw short segment internal fixation of 20 cases of lumbar brucellar spondylitis patients, male 12 cases, female 8 cases, age 20-66 years old, average 41.3 years old. Segmental lesions (L2-S1 were less than 3 segments). X-ray, CT and MRI examinations were performed before operation to determine the inflammatory infiltration and bone destruction in the diseased segment, vertebral pedicle and vertebral body. Postoperative imaging observation of bone graft fusion and vertebral stability, and before and after the surgery the pain visual analogue scale, Cobb angle, Frankel classification of neurological function and laboratory detection of erythrocyte sedimentation rate, C reactive protein (CRP) evaluation indexes were compared and statistically analyzed.

All the 20 patients were followed up for 24-48 months, with an average of 32 months. The follow-up period showed no recurrence, no incision infection and sinus formation, internal fixation, no loss, breakage and loosening. All patients with symptoms of poisoning and infection of brucellosis spondylitis symptom disappeared, preoperative Frankel grade: C grade 6 cases, D grade 5 cases, 9 cases of grade E, the last follow-up Frankel grade: D grade 2 cases, 18 cases of grade E. Visual analogue scale from preoperative (8.85±1.62) points to one week after operation (3.39±0.95) points at the final follow-up (0.81±0.11) points (F=72.05, P<0.05). Convex Cobb angle before and after operation for an average of 15.31 degrees plus or minus 2.42 degrees, one week after operation for 4.28 degrees plus or minus 2.12 degrees at the end of the follow-up, 4.21 degrees - 1.31 degrees (F=214.85, P<0.05). Erythrocyte sedimentation rate from preoperative (40.25±1.51) mm/h recovered to one week after operation (16.46±5.72) mm/h, at the end of follow-up (8.47±0.62) mm/h (F=184.49, P<0.05). C reactive protein by preoperative (71.11±7.22) mg/L recovered to one week after operation (22.44±4.82) mg/L, at the end of follow-up (5.12±0.73) mg/L (F=265.71, P<0.05). The bone graft fusion time was 6-11 months, with an average of 7.4 months.

Brucellosis lumbar spondylitis under the premise of good indications for surgery, as long as the preoperative imaging information and surgery to determine the correct status of vertebral infection, select the removal of posterior lesion, bone graft, vertebral nail set, short section Segment of the fixed surgical plan for the relief of pain, infection control, relieve nerve compression, stabilize the spine, reduce trauma and promote functional recovery is safe and reliable, and has good clinical results.