CAJ | 학술논문

背景：目前不同地区修复原发性腰椎椎间隙感染的方式各不相同，主要方式分为前路、后路及前后路联合修复。而后路修复方式中，肌间隙入路方式得到不少同道的认可，该方案相较于传统后正中入路有其独特优势。目的：评价经后路椎旁肌间隙入路行病灶清除植骨椎弓根螺钉置入内固定修复原发性腰椎椎间隙感染的临床效果。方法：回顾性分析13例原发性腰椎椎间隙感染患者的临床资料，其中L2-L31例，L3-L42例，L4-L54例， L5-S1结果与结论：患者随访12-18个月，无复发，所有患者X射线复查无内固定松动、断裂，均骨性融合。目测类比评分结果显示：平均目测类比评分治疗前8.15分，治疗后1周2.15分，末次随访1.00分，差异有显著性意义(P<0.05)，表明治疗前后疼痛对比差异有显著性意义，治疗后疼痛症状明显缓解。JOA腰椎功能评分结果显示，治疗后所有患者均显效，其中疗效优9例，良3例，中1例，总优良率为92%。提示一期经后路肌间隙入路病灶清除植骨椎弓根螺钉置入内固定为原发性腰椎椎间隙感染患者提供了一种良好的修复方法，可通过椎间孔可直接到达椎间隙，保留了中央的棘突和椎板，减少了对椎旁肌的损伤，同时保存了脊柱韧带复合体，而坚强的脊柱内固定有利于植骨融合，修复后保持了脊柱的稳定性。6例。所有患者腰部疼痛明显，其中9例有下肢放射疼痛症状。13例患者均采用经后路正中切口椎旁肌间隙入路病灶清除植骨椎弓根螺钉置入内固定治疗，治疗后应用目测类比评分法及腰椎日本骨科协会(JOA)功能评分评价临床疗效。
배경：목전불동지구수복원발성요추추간극감염적방식각불상동，주요방식분위전로、후로급전후로연합수복。이후로수복방식중，기간극입로방식득도불소동도적인가，해방안상교우전통후정중입로유기독특우세。목적：평개경후로추방기간극입로행병조청제식골추궁근라정치입내고정수복원발성요추추간극감염적림상효과。방법：회고성분석13례원발성요추추간극감염환자적림상자료，기중L2-L31례，L3-L42례，L4-L54례， L5-S1결과여결론：환자수방12-18개월，무복발，소유환자X사선복사무내고정송동、단렬，균골성융합。목측류비평분결과현시：평균목측류비평분치료전8.15분，치료후1주2.15분，말차수방1.00분，차이유현저성의의(P<0.05)，표명치료전후동통대비차이유현저성의의，치료후동통증상명현완해。JOA요추공능평분결과현시，치료후소유환자균현효，기중료효우9례，량3례，중1례，총우량솔위92%。제시일기경후로기간극입로병조청제식골추궁근라정치입내고정위원발성요추추간극감염환자제공료일충량호적수복방법，가통과추간공가직접도체추간극，보류료중앙적극돌화추판，감소료대추방기적손상，동시보존료척주인대복합체，이견강적척주내고정유리우식골융합，수복후보지료척주적은정성。6례。소유환자요부동통명현，기중9례유하지방사동통증상。13례환자균채용경후로정중절구추방기간극입로병조청제식골추궁근라정치입내고정치료，치료후응용목측류비평분법급요추일본골과협회(JOA)공능평분평개림상료효。
BACKGROUND:The method in repair of primary lumbar intervertebral infection is different in different positions, mainly containing anterior, posterior and anteroposterior pathways. In posterior pathway, muscle gap approach is recognized by many fel ows. This program has its special advantage compared with conventional posteromedial approach. OBJECTIVE:To evaluate the clinical effects of debridement, bone graft and internal fixation of pedicle screw placement in repair of primary lumbar intervertebral infection through posterior paraspinal muscle approach. METHODS:Clinical data of 13 patients with primary lumbar intervertebral infection were analyzed retrospectively. There were one case of L 2-L 3 , two cases of L 3-L 4 , four cases of L 4-L 5 and six cases of L 5-S 1 . Lumbar pain was obvious in al patients. Nine cases suffered from radioactive lower limb pain. Al patients received debridement, bone graft and internal fixation of pedicle screw placement through paraspinal muscle approach via posteromedial incision. After treatment, clinical effects were evaluated using Visual Analog Scale and lumbar Japanese Orthopaedic Association scores. RESULTS AND CONCLUSION:Al patients were fol owed up for 12-18 months, no recurrence. X-ray review demonstrated bony fusion, so loosening and breakage were not found in al patients. Visual Analog Scale scores revealed that Visual Analog Scale score was 8.15 preoperatively, 2.15 at 1 week postoperatively, 1 at final fol ow-up, showing significant difference (P<0.05). There was significant difference in pain between pre-treatment and post-treatment, and pain apparently relieved after treatment. Lumbar Japanese Orthopaedic Association score showed that effective outcomes were found in al patients after treatment, including nine cases of excel ent effects, three cases of good effects, one case of average effects, with the excel ent and good rate of 92%. Above findings confirmed that one-stage debridement, bone graft and internal fixation of pedicle screw placement through posterior muscle gap approach provides a good repair method for patients with primary lumbar intervertebral infection. It can achieve intervertebral space directly through intervertebral foramen, retain the central spinous process and lamina, reduce the injury to paraspinal muscle, and keep spinal ligament complex. However, strong spine fixation contributes to bone fusion, and keeps the stability of the spine after repair.