激光结合抗生素介入性治疗细菌性椎间盘炎的实验研究  

Experimental study on interventional treatment of laser combined with antibiotic in bacterial discitis

作　　者：汪韬[1] 李玉民[1] 管宜可[1] 夏勇[1] 刘牛庆[1] 余国春[1] 韩晓斌[1] 任慧勇[1] 王彦明[1] 黄卫国[1] 

机构地区：[1]民航总医院骨外科,北京100123

出　　处：《感染．炎症．修复》2011年第3期168-171,F0003,共5页Infection Inflammation Repair

基　　金：民航总医院科研课题(2009016)

摘　　要：目的:探讨激光结合抗生素介入性治疗对兔细菌性椎间盘炎(BD)的治疗效果。方法:36只雄性新西兰兔,采用侧方入路暴露兔腰椎间盘、在目标椎间盘髓核内穿刺注入金黄色葡萄球菌的方法,制作兔BD模型,并随机分为6组:模型组、非治疗组、手术治疗组、药物介入治疗组、激光介入治疗组、激光结合药物介入治疗组,每组6只动物。模型组在注入细菌1周后进行腰椎正侧位X线片和MRI检查,并处死取目标椎间盘组织进行细菌培养;非治疗组在注入细菌后不给予特殊治疗;其他各组在目标椎间盘注入细菌1周后,手术治疗组采用开放清创手术治疗,药物介入治疗组在目标椎间盘内注射盐酸万古霉素溶液,激光介入治疗组使用光纤穿刺目标椎间盘、半导体激光照射,激光结合药物介入治疗组在使用激光照射后随即椎间盘内注射盐酸万古霉素溶液。实验动物发生截瘫即处死取材,其他动物在注入细菌6周后处死,对目标椎间盘的大体像和矢状位病理切片进行BD病理学评分。结果:模型组动物MRI结果显示椎间隙狭窄、核磁信号改变,细菌培养阳性率为83.3%(5/6只)。非治疗组动物的尸解和病理切片显示椎间隙狭窄、椎间盘组织溃烂、骨性终板破坏及硬化、硬膜外脓肿形成;手术治疗组表现为椎间隙狭窄、椎体间骨性融合;药物介入治疗组表现为椎间隙狭窄、椎间盘局部组织炎症和局部骨性终板的破坏及硬化;激光介入治疗组和激光结合药物介入治疗组都表现为在椎间盘内出现激光照射髓核后残留的空洞、局部的炎症表现,但激光结合药物介入治疗组局部炎症的表现和组织破坏较激光介入治疗组轻微,髓核部位被纤维组织所取代。手术治疗组的BD评分为(9.70±0.95)分,显著性低于其他各组;药物介入治疗组和激光介入治疗组BD评分分别为(12.00±1.56)分和(12.60±0.97)分,两者均显著低于非治疗�Objective：To assess the efficacy of laser combined with antibiotic interventional treatment on bacterial discitis （BD） in rabbits. Methods：BD model was replicated in 36 male rabbits by injecting Staphylococcus aureus to nucleus pulposus of target intervertebral disc （IVD） through lateral approach, and the animals were divided into 6 groups randomly （n=6 in each group）： model group, non-treatment group, operation group, antibiotic interventional group, laser interventional group, laser and antibiotic interventional group. The rabbits in model group were examined by lumbar X-ray and MRI, and target IVD was harvested for bacteria culture 1 week after injection of bacteria. Non-treatment group received no treatment after injection of bacteria. In other groups the rabbits received treatments 1 week after injecting bacte- ria as follows： those of the operation group received open debridement, and those of antibiotic interventional group received vancomycin hydrochloride injection into the target IVD, those in laser interventional group received radiation treatment with semiconductor laser, and laser and antibiotic interventional group received both laser radiation and vancomycin injection. The rabbits were sacrificed when paraplegia occurred and the survivors were sacrificed 6 weeks after the injection of bacteria for pathological examination of the target IVD. The pathological changes in IVDs were observed and the degree of BE） was scored according to the histological scoring system. Results： In the model group, MRI showed narrowed disc space,changed T1 and T2 signal, and 83.3% positive rate of bacterial culture. In non-treatment group, autopsy and pathological examination showed narrowed disc space, inflammatory changes in disc tissue, extensive erosion and sclerosis of bony end-plates and epidural abscess. Narrowed disc space and bone fusion were observed in operation group. In antibiotic interventional group, narrowed disc space,local inflammatory changes in disc tissue, local erosion and sc

关 键 词：椎间盘炎 金黄色葡萄球菌 介入性治疗 激光 万古霉素 兔 

分 类 号：R454.2[医药卫生—治疗学]