Safety Evaluation And Curative Effect Analysis Of Disease Vertebral Nailing And Short-segment Pedicle Internal Fixation For Brucellar Spondylitis Of The Lumbar Vertebrae

Objective To discuss the effect and security of posterior one-stage focus clearance,intertransverse process fusion and affected-vertebrae short-segment pedicle internal fixation in the treatment of lumbar brucellosis spondylitis.Methods From March of 2009 to May of 2015 posterior one-stage focus clearance,intertransverse process fusion and affected-vertebrae short-segment pedicle internal fixation were performed in 20 cases of patients with lumbar brucellosis spondylitis,male 12 cases,female 8 cases,aged from 20 to 66,mean age 41.3 years old.The affected segments were from L2 to S1 and equal to 3 or below.X-ray,CT scan and MRI were performed before the operation to identify the inflammatory infiltration and bone destruction of the affected segment,pedicle and vertebrae.Vertebral internal fixation and focus clearance were performed if the bone of the affected pedicle was in good condition,the bone of the vertebrae was inflammatory infiltration,there was no central bone destruction and the lowest remaining effective height was more than half of vertebrae.The Cobb angle before and after the operation,visual analogue scale,Frankel grading,erythrocyte sedimentation rata and C-reactive protein were analyzed by statistics and bone fusion and stability of vertebae were observed.Results All of the 20 cases of patients were followed up after the operation.The follow-up time was 24 to 48 months,32 months on average.The interbody bone fused after theoperation and there was no broken nails,broken board and recrudescence.The poisoning symptoms of brucellosis of all the patients disappeared.The average Cobb angle of kyphosis was 15.31°±2.42° after the operation,4.28°±2.12° one week after the operation and 4.21°±1.31°the last follow-up;The score of visual analogue scale was 8.85±1.62 before the operation,3.39±0.95 one week after the operation and 0.81±0.11 the last follow-up.Frankel grading before the operation: there were 6 cases of Grade C,5 cases of Grade D and 9 cases of Grade E;Frankel grading of the last follow-up: there were 2 cases of Grade D and 18 cases of Grade E.The erythrocyte sedimentation rata was(40.25±1.51)mm/h before the operation,reduced to(16.46±5.72)mm/h one week after the operation and was(8.47±0.62)mm/h the last follow-up.The content of C-reactive protein was(71.11±7.22)mg/L before the operation,reduced to(22.44±4.82)mg/L one week after the operation and was(5.12±0.73)mg/L the last follow-up.The bone fusion time was 6 to 11 months,7.4months on average.Conclusion Lumbar brucellosis spondylitis in the mastery of surgical indications,as long as the preoperative basis of imaging data and surgery to correctly determine the vertebral infection,select the posterior lesions removed,bone graft,stenosis,short segment The internal fixation regimen is safe and reliable for relieving pain,controlling infection,relieving nerve compression,stabilizing the spine,reducing trauma,promoting functional recovery,and has a good clinical effect.