腰椎后路固定联合前路病灶清除治疗腰椎间隙感染1例  

Posterior lumbar fixation combined with anterior debridement in the treatment of lumbar space infection: a case report

作　　者：孟赛克 刘帅 郭阿雷 王林飞 MENG Sai-ke;LIU Shuai;GUO A-lei;WANG Lin-fei(Department of Spinal Orthopaedics and Bone Oncology,Pingmei Shenma Medical Group General Hospital,Pingdingshan,Henan 467000,China)

机构地区：[1]平煤神马医疗集团总医院脊柱骨科骨肿瘤科,河南平顶山467000

出　　处：《医药论坛杂志》2023年第2期62-66,共5页Journal of Medical Forum

摘　　要：目的 分析腰椎后路固定联合前路病灶清除治疗腰椎间隙感染的临床疗效。方法 平煤神马医疗集团总医院于2020年5月接诊一例腰椎间隙感染,采用腰椎后路固定联合前路病灶清除进行治疗。术后进行24个月随访。结果 手术进展顺利,历时5 h,术中出血量约900 mL。患者术后疼痛明显缓解,12天后拆线。术后病灶组织细菌培养结果显示患者为金黄色葡萄球菌感染。术后6个月的X光片显示感染灶清除彻底,腰椎间融合良好,锥体内固定位置良好,未出现钉棒断裂情况,ASIA等级为E级。术后12个月后取出椎弓根螺钉,做核磁共振(MRI)检查,恢复良好。术后3个月患者戴腰围能正常站立和行走。结论 原发腰椎间隙感染临床上比较少见,多见于血源性感染,采用腰椎后路固定联合前路病灶清除进行治疗,能重建脊柱稳定,尽快恢复,减轻患者痛苦。Objective To analyze the clinical effect of posterior lumbar fixation combined with anterior debridement in the treatment of lumbar space infection. Methods In May 2020, our hospital received a case of lumbar intervertebral space infection, which was treated by posterior lumbar fixation combined with anterior focal debridement and lumbar bone graft fusion.The postoperative follow-up was 24 months. Results The operation progressed smoothly, lasted for 5 hours, and the amount of intraoperative bleeding was about 900 mL. The postoperative pain was significantly relieved and the suture was removed 12 days later. The results of postoperative bacterial culture showed that the patient was infected with Staphylococcus aureus. The X-ray films at 1 and 6 months after operation showed that the infection focus was completely removed, the lumbar interbody fusion was good, the fixation position in the cone was good, there was no nail rod fracture, and the ASIA grade was grade E.12 months after operation, the pedicle screw was removed and MRI was performed, and the recovery was good. Three months after operation, the patient could stand and walk normally with waist circumference. Conclusion Primary lumbar intervertebral space infection is rare in clinic, mostly seen in blood borne infection. The treatment of posterior lumbar fixation combined with anterior lesion removal and lumbar bone graft fusion can rebuild the stability of spine, recover as soon as possible and reduce the pain of patients.

关 键 词：腰椎 原发腰椎间隙感染 腰椎后路固定 椎弓根螺钉 金黄色葡萄球菌 

分 类 号：R681.5[医药卫生—骨科学]