一期后、前路手术治疗非特异性腰椎间隙感染的疗效  

The effect of one-stage posterior-anterior surgery for treatment of non-specific lumbar intervertebral space infection

作　　者：胡金平 胡德新 朱均 胡胜平 费骏 HU Jin-ping;HU De-xin;ZHU Jun;HU Sheng-ping;FEI Jun(Dept of Orthopaedics,Hangzhou Chest Hospital Affiliated of Zhejiang University School of Medicine,Hangzhou,Zhejiang 310003,China)

机构地区：[1]浙江大学医学院附属杭州市胸科医院骨科,浙江杭州310003

出　　处：《临床骨科杂志》2021年第5期650-655,共6页Journal of Clinical Orthopaedics

基　　金：浙江省卫健委2018年医药卫生科技项目(编号:2018KY606);浙江省卫健委2019年医药卫生科技项目(编号:2019KY515)。

摘　　要：目的探讨一期后、前路手术治疗非特异性腰椎间隙感染的疗效。方法采用一期后路肌间隙椎弓根螺钉内固定联合前路微创切口病灶清除髂骨植骨治疗23例单节段非特异性腰椎间隙感染患者。记录手术情况,比较患者手术前后红细胞沉降率(ESR)、C-反应蛋白(CRP)指标,采用腰痛VAS评分、ODI评估腰部疼痛及功能障碍程度。结果手术时间220~280(249.3±18.2)min,术中出血量265~365(316.1±29.3)ml。患者均获得随访,时间36~58(46.7±6.9)个月。2例术前及术后送检均未明确病原菌,病理结果提示炎性组织且常规抗感染治疗有效;病原学培养结果阳性21例(21/23),其中2例血培养及术前穿刺均证实为金黄色葡萄球菌;4例术前穿刺结果为阴性,但术后送检脓液培养明确病原菌;15例术前穿刺及术后送检均明确同一致病菌。ESR、CRP、腰痛VAS评分、ODI末次随访时均较术前明显降低(P<0.001)。术后5例下肢神经刺激症状,3例髂骨取骨区疼痛,2例抗感染周期内肝功能异常。结论一期后、前路手术治疗非特异性腰椎间隙感染,临床疗效满意,具有手术时间短、术中出血少、病灶清除彻底、重建及维护脊柱稳定的优点。Objective To investigate the clinical efficacy of one-stage posterior-anterior surgery for non-specific lumbar intervertebral space infection.Methods One-stage posterior intramuscular pedicle screw fixation combined with anterior minimally invasive incision debridement plus iliac bone grafting were used to treat 23 patients with single-segment non-specific lumbar intervertebral infection.The sugery situation was recorded,and the indicators of pre-and post-operative erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)were compared;the pain visual analogue scale(VAS)and Oswestry dysfunction index(ODI)were used to assess the degree of lumbar pain and dysfunction.Results The operation time was 220~280(249.3±18.2)min,and the intraoperative blood loss was 265~365(316.1±29.3)ml.All patients were followed up for 36~58(46.7±6.9)months.In orther 2 cases,the pathogens were not identified before and after the operation,and the pathological results showed that they were the inflammatory tissue,and the conventional anti-infective treatment was effective.The results of etiological culture:21 cases were positive(21/23),of which 2 cases of blood culture and preoperative puncture were confirmed with Staphylococcus aureus;and 4 cases of preoperative puncture results were negative,but the postoperative pus culture was confirmed with pathogen;the same pathogen was confirmed in all the 15 cases by preoperative puncture and postoperative examination.At the last follow-up,ESR and CRP,and VAS of the lumbar pain,ODI were significantly decreased than the preoperation(P<0.001).Five cases had irritation symptoms after operation,3 cases had pain in the iliac bone removal area,and 2 cases had abnormal liver function during the anti-infection periods.Conclusions One-stage posterior-anterior surgery have satisfactory effect in the treatment of single-segment non-specific lumbar intervertebral infection,which have the advantages of shorter operative time,less intraopetative blood loss,and can completely remove lesion,reconstruct and mai

关 键 词：腰椎间隙感染 手术入路 

分 类 号：R681.51[医药卫生—骨科学] R687.3[医药卫生—外科学]