一期病灶清除结合万古霉素骨水泥钛网治疗急性腰椎化脓性骨髓炎  

One-stage radical debridement combined with reconstruction by vancomycin bone cement and titanium mesh for acute lumbar pyogenic osteomyelitis

作　　者：尤瑞金[1] 杨德育[1] 王月娥[1] 苏在权[1] YOU Rui-jin;YANG De-yu;WANG Yue-e;SU Zai-quan(Department of Orthopaedics,The 180^th Hospital of PLA,Quanzhou 362000,China)

机构地区：[1]解放军第180医院骨科,福建泉州362000

出　　处：《中国矫形外科杂志》2019年第3期215-219,共5页Orthopedic Journal of China

摘　　要：[目的]探讨一期病灶清除结合万古霉素骨水泥钛网治疗急性腰椎化脓性骨髓炎的可行性和临床疗效。[方法] 2007年6月～2014年9月本科采用一期病灶清除结合万古霉素骨水泥钛网,辅以后路钉棒固定及闭式冲洗治疗急性腰椎化脓性骨髓炎12例。其中男8例,女4例;年龄32～56岁,平均(38.34±6.55)岁。术后观察患者体温、症状改善情况。记录围手术期和随访资料,采用疼痛视觉模拟评分(VAS)和日本骨科学会(JOA)腰背痛评分评价临床效果。[结果]术中见病变椎体均有脓液形成,并伴有不同程度的椎体破坏。12例患者细菌培养均为阳性,7例为金黄色葡萄球菌,3例为大肠埃希菌,2例为链球菌。患者术后体温均逐渐下降,至术后0～3 d,平均(0.42±0.900) d,体温完全恢复正常。随访时间20～52个月,平均(31.53±5.86)个月。10例患者于术后3个月内血沉及C反应蛋白恢复正常,2例于术后6个月内恢复正常。随访期间所有患者无感染复发,未发现严重并发症。随时间延长,VAS评分显著减少,而JOA评分显著增加,不同时间点差异均有统计学意义(P<0.05)。至末次随访,影像检查未见病灶复发,无内固定物松动及移位,未发生脊柱畸形。12例患者中4例分别于术后22、27、30、31个月X线片显示椎体间骨桥形成,达到骨性融合。[结论]一期病灶清除结合万古霉素骨水泥钛网治疗急性腰椎化脓性骨髓炎,可以彻底清除病灶、防止感染复发和重建脊柱稳定性,是一种有效的治疗方法。[Objective] To investigate the feasibility and efficacy of one-stage radical debridement combined with reconstruction by vancomycin bone cement and titanium mesh for the treatment of acute lumbar pyogenic osteomyelitis.[Methods]From June 2007 to September 2014,12 patients,including 8 males and 4 females aged from 32 to 56 years with an average of(38.34±6.55) years,received one-stage radical debridement combined with reconstruction by vancomycin bone cement,titanium mesh and pedicle screw fixation for acute lumbar pyogenic osteomyelitis.The perioperative and follow-up documents were collected,the visual analogue scale(VAS) for pain and the Japanese Orthopaedic Association Scores(JOA) for lumbar function were used for assessment of the clinical consequences as well.[Results] During operation,abscess was found in all patients accompanied with different extents of vertebral destruction.Positive results of bacterial culture were proved in all patients,including Staphylococcus aureus in 7,Escherichia coli in 3 and Streptococcus in 2 patients.The temperature gradually decreased in the 12 patients to the normal level at 0~3 days(mean,0.42 ± 0.90 days) postoperatively.The follow up lasted for 20 to 52 months(mean,31.53±5.86 months).The erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) returned to the normal level within 3 months in 10 patients,whereas 6 months in 2 patients.During the follow-up period,no infection recurrence and serious complications happened in any of them.As time went on the VAS significantly decreased,while the JOA score significantly increased(P<0.05).At the latest follow up the radiographic images revealed that no lesion relapse,loosening or displacement of implants and spinal deformities occurred in any patient.Of the 12 patients,4 patients got bony fusion respectivelyat 22,27,30 and 31 months after operation,which presented as continuous bone bridge over the intervertebral spaces.[Conclusion] The one-stage radical debridement combinedwith reconstruction by vancomycin bone cement an

关 键 词：腰椎急性骨髓炎 感染 万古霉素 内固定器 

分 类 号：R681.2[医药卫生—骨科学]