原发性与脊柱术后化脓性脊柱炎的对比研究及预后因素分析  

Comparative study of native vertebral osteomyelitis and pyogenic postoperative and analysis of prognostic factors

作　　者：麦麦提艾力·阿卜杜热西提 木拉德·买尔旦 胡尔西旦·克里木 颜飞华[2] 巴吾东·买合苏木 牙克甫·阿不力孜 西尔艾力·赛买提 周洋[1] 徐韬[1] 买尔旦·买买提[1] 盛伟斌[1] Maimaitiaili·Abudurexiti;Muradil·Mardan;Huerxidan·Kelimu;Yan Feihua;Bawudong·Maihesumu;Yakup·Abliz;Xirali·Samat;Zhou Yang;Xu Tao;Mardan·Mamat;Sheng Weibing(Department of Spinal Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Joint Orthopaedics,Kashgar First People's Hospital,Kashgar 844400,China;Department of Clinical Medicine,Medical College of Tongji University,Shanghai 200092,China)

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐830054 [2]喀什地区第一人民医院关节骨科,喀什844400 [3]上海市同济大学医学院临床医学系,上海200092

出　　处：《中华骨科杂志》2022年第15期950-960,共11页Chinese Journal of Orthopaedics

摘　　要：目的:比较原发性化脓性脊柱炎(native vertebral osteomyelitis,NVO)与脊柱术后化脓性脊柱炎(postoperative vertebral osteomyelitis,PVO)的微生物学、临床特点及治疗效果,并分析影响预后的因素。方法:回顾性分析2010年12月至2019年12月诊治化脓性脊柱炎46例患者的病历资料,按发生原因分为NVO组和PVO组。NVO组30例,男18例,女12例;年龄(50.47±20.45)岁(范围15~73岁);病变位于腰椎23例(76.7%)、胸椎5例(16.7%)、颈椎2例(6.7%)。PVO组16例,男10例,女6例;年龄(52.13±18.80)岁(范围14~73岁);病变位于腰椎11例(68.8%)、胸椎5例(31.2%)。术前28例患者存在神经功能障碍,按照美国脊柱损伤协会(American Spinal Injury Association,ASIA)神经功能分级,D级25例(NVO组16例,PVO组9例),C级3例(NVO组1例,PVO组2例)。所有患者先予卧床、营养支持和抗生素治疗,效果不佳或症状加重者采用手术治疗。观察指标包括白细胞计数、红细胞沉降率和C-反应蛋白评价感染控制情况,通过影像学检查评估内固定装置有无松动、断裂。同时记录疼痛视觉模拟评分(visual analogue scale,VAS)、ASIA神经功能分级的变化以评价临床疗效。结果:NVO组2例患者行抗感染保守治疗,余28例患者均顺利完成手术,术中病变组织送病检,结果均诊断为化脓性脊柱炎。所有患者均获12~24个月随访,均采用静脉注射与口服抗生素治疗,PVO组抗生素治疗总时间较NVO组延长,但差异无统计学意义(t=1.74,P=0.088)。两组患者术后各随访时间点白细胞计数、C-反应蛋白、红细胞沉降率、VAS评分均较术前明显改善(P<0.05)。两组间术后相同时间点白细胞计数、C-反应蛋白、红细胞沉降率、VAS评分的差异均无统计学意义(P>0.05)。术后患者神经功能较术前明显改善,NVO组16例患者ASIA分级由D级恢复至E级、1例自C级恢复至D级;PVO组9例由D级恢复至E级,2例自C级恢复至D级。至末次随访NVO组3例复发,复发率为10Objective To compare the microbiology,clinical characteristics and therapeutic efficacy of native suppurative spondylitis(NVO)and postoperative suppurative spondylitis(PVO),and analyze the factors affecting the prognosis.Methods All patients with suppurative spondylitis were retrospectively analyzed from December 2010 to December 2019.A total of 46 patients were enrolled in this study.They were divided into two groups.There were 30 cases in NVO group,18 males and 12 females;The age was 50.47±20.45 years,aged 15-73 years.There were 16 cases in PVO group,10 males and 6 females;The age was 52.13±18.80 years,aged 14-73 years.In group NVO,23 cases(76.7%)were in lumbar vertebrae,5 cases(16.7%)in thoracic vertebrae and 2 cases(6.7%)in cervical vertebrae;in group PVO,11 cases(68.8%)in lumbar vertebrae and 5 cases(31.2%)in thoracic vertebrae.Twenty-eight patients had neurological dysfunction before surgery.There were 25 cases of grade D(16 cases in group NVO and 9 cases in group PVO)and 3 cases of grade C(1 case in group NVO and 2 cases in group PVO),following the instructions of American Spinal Injury Association(ASIA)neurological function classification.All patients were given bed rest,nutritional support and antibiotic therapy;surgical treatment for patients with poor outcomes or aggravated symptoms.The patients were followed up after operation,the observation indexes included leukocyte count,erythrocyte sedimentation rate and C-reactive protein to evaluate the postoperative curative effect.The internal fixation device was evaluated for looseness and fracture by imaging examination.At the same time,the changes of visual analogue scale,ASIA neurological function grade were recorded to evaluate the clinical efficacy.Results Two patients in NVO group were treated with antibiotics,and all the other patients successfully completed the operation.The diseased tissues were sent for pathological examination during the operation.The results showed that they were diagnosed as suppurative spondylitis.All patients were followed u

关 键 词：脊柱 感染 脊柱融合术 手术后并发症 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]