目的:本研究的目的是评估后路减压的效果,融合固定术治疗脊柱痛风。脊柱痛风是一种累及脊柱的痛风性关节炎,会影响脊柱的所有部分。目前,脊髓痛风的病因和发病机制尚不清楚,目前还没有明确的治疗脊髓痛风的方法。
方法:这是一个由7名患者(7名男性)接受后路减压的病例系列,2016年1月至2020年1月,融合固定术治疗脊柱痛风。体格检查,射线照相术,CT,MRI,使用日本骨科协会(JOA)评分和视觉模拟量表(VAS)评分来评估该程序的效果。所有患者每3个月随访一次。评价时间点为术后12个月。使用SPSS22.0(IBM,Armonk,NY,美国)。
结果:术前JOA评分为13.43±6.55,VAS评分为7.43±1.51。术后12个月,JOA评分为24.43±3.74,VAS评分为0.86±0.90。手术后12个月,与手术前相比,JOA和VAS评分显著改善(分别为P=0.004和P=0.002).所有患者均未因积极合理控制尿酸而再次进行痛风手术。未报告螺钉松动或移位。只有一个螺钉尾盖松开。影像学检查显示痛风无明显积聚或周围骨质破坏,节段不稳定性明显改善。7例患者的神经症状没有进行性加重。
结论:后入路减压,融合和固定可以稳定椎体,去除痛风,直接解除局部脊髓压迫。该方法是治疗脊髓痛风的可靠手术选择。
OBJECTIVE: The aim of the present study was to assess the effect of posterior decompression, fusion and fixation in the treatment of spinal gout. Spinal gout is a disease of gouty arthritis involving the spine, which can affect all segments of the spine. At present, the etiology and pathogenesis of spinal gout are not clear, and there are no definite methods for the treatment of spinal gout.
METHODS: This was a
case series of seven patients (seven men) who underwent posterior decompression, fusion and fixation in the treatment of spinal gout between January 2016 and January 2020. Physical examination, radiography, CT, MRI, Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were used to evaluate the effect of this procedure. All patients were followed up every 3 months. The evaluation time point was 12 months after the operation. Comparisons of the functional indexes of the patients before and after the operation were performed using SPSS 22.0 (IBM, Armonk, NY, USA).
RESULTS: The JOA score was 13.43 ± 6.55 and the VAS score was 7.43 ± 1.51 preoperatively. The JOA score was 24.43 ± 3.74 and the VAS score was 0.86 ± 0.90 postoperatively at 12 months after surgery. At 12 months after surgery, the JOA and VAS score showed significant improvements when compared with those before surgery (P = 0.004 and P = 0.002, respectively). None of the patients had re-surgery of the gout due to actively and reasonably controlling uric acid. No loosening or displacement of screws was reported. There was only one screw tail cap loosening. Radiographic examination revealed that there was no obvious accumulation of gout or surrounding bone destruction, and the segmental instability was significantly improved. There was no progressive aggravation of neurological symptoms of the seven patients.
CONCLUSIONS: Posterior approach decompression, fusion and fixation can stabilize the vertebral body, remove gout and directly relieve local spinal cord compression. The method is a reliable surgical choice for the treatment of spinal gout.