Abstract：Objective To evaluate the two different surgical treatment for lumbar brucellosis spondylitis to provide a scientific basis for their surgical indications.Methods One hundred and forty-three cases of patients with lumbar brucellosis spondylitis from January 2002 to July 2013 in the First Affiliated Hospital of Hebei North University were analyzed retrospectively. Seventy-six cases in group A were treated by first intention posterior debridement, bone fusion and pedicle screw fixation, of which there were 41 male patients and 35 female patients, age (45.1±2.4)years. There was 1 case in grade C, 43 cases in grade D and 32 cases in grade E by American Spinal Injury Association (ASIA) classification. Sixty-seven cases of patients in group B were treated by first intention anterior debridement, bone fusion and pedicle screw fixation, of which there were 36 male patients and 31 female patients, age (44.2±2.6)years. There was 1 case in grade C, 39 cases in grade D and 27 cases in grade E by ASIA. The operation time, the amount of bleeding during operation, the hospitalization time, visual analogue scale (VAS) before and after the operation, AISA classification, the erythrocyte sedimentation rate (ESR), the change of Kyphosis angle (Cobb angle), bone fusion time and postoperative complications of the two groups were compared.Results All of the 143 cases of patients were treated by operation successfully. The lesions resected during the operation were inspected by pathological examination and conformed to Brucellosis. There were 76 cases in group A, the wound of 2 cases was infected after the operation, and the focuses of 8 cases were treated by second intention anterior debridement because of the incomplete debridement. All of the 67 cases of patients in group B healed by first intention, no lesion recurrence. All of the patients were followed up for 14 to 38 months, 25 months on average. The VAS, ASIA, Cobb angle and ESR of each group on the different time point after the operation were compared with that before the operation, the difference had statistical significance (all P values＜0.05). The operation time, the amount of bleeding during operation and hospitalization time of group B were much less than that of group A and the difference had statistical significance (t valve was 18.514, 42.627 and 11.801, all P values＜0.01). The VAS, Cobb angle and ESR of the two group after the operation were compared, the difference had no statistical significance (all P values＞0.05) while the difference of ASIA had statistical significance (Z=3.061, P＜0.01). The difference of bone fusion time of the two groups had no statistical significance (P＞0.05).Conclusions Both of the two surgical treatments can clear the focus effectively, alleviate or relieve the pain, maintain the stability of the spine, improve bone fusion and control of the infection. Simple posterior operation is better than the first intention posterior operation on the aspect of shorter operative time, less blood loss, less time in hospital and improving the nerve function, but the first intention posterior operation is better than simple posterior operation on the aspect of removal of vertebral abscess. The posterior operation is suitable for the lesion after spinal column, especially the spinal nerve compression while the first intention posterior debridement is suitable for the bone destruction of anterior spinal column structure, especially that with vertebral abscess.
杨新明，张磊，贾永利，胡长波，任义行，张振梁，成垚昱，康聪. 后路与前后路联合病灶清除植骨内固定术治疗腰椎布鲁杆菌病性脊柱炎疗效比较[J]. 中华解剖与临床杂志, 2015, 20(5): 428-434.
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