Establishment and clinical application of one-stage posterior limited lesion clearance and internal fixation combined with personalized drug therapy system for brucellosis spondylitis
Yang Xinming, Jia Yongli, Zhang Ying, Yin Yanlin, Zhang Peinan, Tian Ye, Yao Yao, Chen Lixing
Department of Orthopaedics, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
Abstract：Objective This study aimed to investigate the feasibility and clinical efficacy of one-stage limited focus debridement and posterior internal fixation system combined with individualized medication therapy in the treatment of brucella spondylitis (BS). Methods A total of 44 patients (26 males and 18 females; 32-65 years old) with BS who underwent one-stage limited focus debridement and posterior internal fixation system combined with individualized medication therapy in the Department of Orthopedics, the First Affiliated Hospital of Hebei North University, from January 2014 to January 2019, were retrospectively reviewed. The disease time varied from 3 months to 7 months. The incidence of segment: 2 cases of thoracolumbar, 32 cases of lumbar, and 10 cases of lumbosacral. Observation index: (1) Perioperative indexes such as operation time and intraoperative blood loss; (2) The inflammatory indexes such as erythrocyte sedimentation rate(ESR), C-reactive protein (CRP), rosebengal plate agglutination test (RBPT), back pain visual analogue scale (VAS) score, and Oswestry disability index (ODI) score were compared before the operation and 3, 6, 9, and 12 months after the operation. (3) The patient's American Spinal Injury Association(ASIA) neurological function classification and body mass index (BMI) were compared before the operation and at the last follow-up. (4) Spinal stability, inflammatory control, spine and nerve compression, bone graft fusion, and adjacent vertebrae degeneration were assessed via imaging examination. Results The incisions of 44 patients in this group healed at first stage, and there was no impairment of the liver and kidney function during the personalized drug therapy. The patients reached the clinical cure standard at 3-9 months after the operation. Twenty-eight patients received reoperation to remove the internal fixation at 18-26 months after the operation, and the samples were sent to histological examination (no positive inflammatory manifestation was reported). (1) Operation time was 70-120 (80±10) min, and blood loss volume was 200-400 (250±20) mL. (2) Preoperative ESR, CRP, VAS, and ODI scores were (55.42±11.42) mm/1 h, (55.40±17.56) mg/L, (6.56±1.33) points, and 68.84%±4.55%, respectively. Postoperative indexes at various time points all improved compared with that before the operation, and the difference was statistically significant (F=87.58, 92.54, 54.28, 165.48, all P value <0.001). There were 44 positive patients with RBPT before operation, 6, 1 and 0 patients 3, 6 and 9 months after operation, respectively. (3) Sixteen cases of preoperative neurological impairment were alleviated before the last follow-up, and the Asian classification improved from grade C (6 cases) and grade D (10 cases) to grade D (1 case) and grade E (15 cases). The patient's preoperative BMI improved from 16.8±0.2 kg/m2 to 23.5±1.8 kg/m2, and the nutritional status was good. The difference was statistically significant (t=2.14, P=0.031). (4) X-ray examination at follow-up revealed that the pedicle screw provided satisfactory pullout strength (i.e., no loosening, breakage, or pullout) whether or not it was inserted on the diseased vertebrae or on the normal vertebrae. The spine was stable, and the intervertebral bone graft particles were not absorbed or fell off, and the time of the grafted bone fusion was 3-9 months. MRI showed that the original diseased vertebrae had no inflammatory manifestations, and bone destruction lesions were repaired. Paravertebral and intraspinal abscesses and inflammatory granulation tissue or necrotic intervertebral discs were completely removed; the spinal cord or cauda equina nerves were in order without compression. The spine was stable, and no degeneration of adjacent vertebrae was found in the last follow-up. MRI showed no inflammatory manifestations in the vertebral body of the original lesion, repair of bone destruction lesions, complete clearance of paravertebral and intraspinal abscesses and inflammatory granulation tissue or necrotic intervertebral discs, no spinal cord or cauda equina nerve compression, and stabilized spine. No adjacent vertebral degeneration was found at the last follow-up. Conclusion Limited debridement has the advantages of minimal invasion, low bleeding, and focal cleaning. Individualized medication has the advantages of rational sensitive drug administration, precise dosage, and conforming to pharmacokinetics. Thus, one-stage posterior limited debridement and internal fixation combined with individualized medication therapy system for BS is safe and feasible with satisfactory clinical efficacy.
杨新明, 贾永利, 张瑛, 阴彦林, 张培楠, 田野, 姚尧, 陈丽星. 一期后路有限病灶清除内固定联合个体化药物治疗体系在布病脊柱炎治疗中的应用[J]. 中华解剖与临床杂志, 2022, 27(2): 98-105.
Yang Xinming, Jia Yongli, Zhang Ying, Yin Yanlin, Zhang Peinan, Tian Ye, Yao Yao, Chen Lixing. Establishment and clinical application of one-stage posterior limited lesion clearance and internal fixation combined with personalized drug therapy system for brucellosis spondylitis. Chinese Journal of Anatomy and Clinics, 2022, 27(2): 98-105.
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2022, Vol. 27 
