后路经皮椎弓根螺钉固定治疗胸腰椎前路术后感染  

The surgical treatment for spinal deep wound infection following anterior spine surgery by percutaneous pedicle screw fixation

作　　者：刘玉武[1] 程志军[1] 

机构地区：[1]江山市人民医院骨一科,浙江江山324100

出　　处：《临床骨科杂志》2015年第2期167-170,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨胸腰椎前路术后并发切口深部感染的外科治疗措施。方法对12例胸腰椎骨折前路术后感染患者行后路经皮椎弓根螺钉固定联合前路内植物取出、清创、植骨融合手术治疗。通过影像学检查、ODI评分、VAS评分评价治疗效果。结果患者取出内植物后疼痛均消失,术后摄片提示胸腰椎侧凸角及后凸角均获得纠正,术后体温及血沉、C-反应蛋白均正常,患者均获得随访,时间1~4年,患者术后感染无复发,切口与窦道均愈合。术后3个月摄片复查提示胸腰椎侧弯矫正无丢失,胸腰椎稳定性存在,骨折线模糊;术后12个月复查均已植骨融合。末次随访的ODI评分和VAS较术前均显著下降（P〈0.01）。结论后路经皮椎弓根螺钉固定联合前路内植物取出、清创、植骨融合手术是治疗胸腰椎骨折前路术后并发切口深部感染的有效手段,可以重建脊柱的稳定性,允许患者早期下床负重活动。Objective To investigate surgical treatment of incision deep infection after anterior approach for thoracic and lumbar fractures. Methods 12 patients got deep infection after spine fusion with implant via anterolateral approach. All cases underwent anterior debridement and posterior minimally invasive pedicle screw fixation. The clinical outcomes were assessed using the Oswestry disability index（ ODI）,visual analog scale（ VAS） of pain and lordotic angle. Results The symptoms and signs of infection were disappeared in all patients. The scoliosis and kyphosis of thoracolumbar assessed by postoperative X-ray photograph were corrected entirely. The temperature,ESR and CRP indication returned to normal and no infection recurred during follow-up of 1 ~ 4 years. The incision and sinus were healed. Three months after operation,the X-ray photograph prompted that there were no change of stability and no loss correction in thoracolumbar fracture site blurred. 12 months after operation,all cases showed bone fusion by Xray. The serial changes of functional outcomes of the ODI and VAS of pain in the back and leg showed statistically significant decline after operation. The difference of ODI and VAS scores between preoperation and the last follow-up were significant（ P〈0. 01）. Conclusions Pedicle screw fixation with minimally invasive technique combined with implant removal via anterolateral approach can cure spinal deep wound infection extensively and restore stability of the spine to avoid the intervertebral height and（ or） spinal corrective angle loss,the stability of spine also contribute to early ambulation and reduce hospitalization time and hospitalization expenses.

关 键 词：胸腰椎前路术后 切口深部感染 内植物取出 椎弓根螺钉固定 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]