扩大椎间孔入路联合封闭负压引流治疗11例中老年原发性胸腰椎椎间隙感染的临床报告  

Clinical report on the treatment of 11 middle-aged and elderly patients with primary thoracolumbar intervertebral space infection by expanding intervertebral foramen approach combined with closed negative pressure drainage

作　　者：邢皓 常正奇 崔浩诚 于秀淳 Xing Hao;Chang Zhengqi;Cui Haocheng;Yu Xiuchun(Department of Osteopathy,960th Hospital of PLA,No.25 tianqiao district Normal Road,Jinan,Shandong,250031 Jinan,China)

机构地区：[1]解放军联勤保障部队第九六〇医院骨病科

出　　处：《中华老年骨科与康复电子杂志》2024年第2期80-87,共8页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：山东省自然科学基金(ZR202212010123);2023年度解放军第九六〇医院青年自主创新科学基金(2023FY03);军队中医药服务能力培育与提升专项基金资助。

摘　　要：目的中老年原发性脊柱感染尤其是蔓延到椎间隙的感染对脊柱外科医生来说是一个非常大的挑战,传统手术因创伤大对于中老年患者耐受率低、治愈率低。方法首次应用扩大椎间孔入路清创+负压引流海绵(vaccum sealing drainage,VSD)植入到胸腰椎间隙联合治疗原发性脊椎感染,通过分期微创手术来提高手术率,封闭负压引流治疗来降低复发率。分析2018年6月至2022年11月在我院接受VSD治疗,无脊柱畸形且累及到椎间隙的胸腰椎感染患者共11例。随访并观察术后功能评分。结果11例患者均在术后3个月随访中均获得了临床治愈,没有发生与手术相关的死亡。1例患者在术后5个月时死于急性脑梗死,其余10例患者完成了12个月的随访。所有患者的JOA评分在接受VSD治疗后均有明显改善,末次随访未有复发。结论扩大椎间孔入路清创联合VSD治疗中老年原发性胸腰椎感染是可行、安全、有效的,中短期随访效果明确。Objective Dealing with primary spinal infections in the elderly,especially when they spread to the intervertebral space,presents a major challenge for spinal surgeons.Traditional surgery has a low tolerance and cure rate for elderly patients because of the significant trauma it inflicts.Methods The initial use of the expanded intervertebral foramen approach for debridement,combined with the implantation of a negative pressure drainage sponge(Vaccum Sealing Drainage,VSD)into the thoracolumbar space for treating primary spinal infection,aims to enhance the surgical success rate through staged minimally invasive procedures and to decrease the recurrence rate through closed negative pressure drainage treatment.From June 2018,to November 2022,our hospital treated a total of 11 patients with thoracolumbar infection using VSD.None of these patients had spinal deformities or involvement of intervertebral spaces.After the surgery,make sure to monitor and observethe functional scores of the patient.Results All 11 patients achieved clinical cure during the 3-month follow-up after surgery,with no surgical-related deaths.However,one patient died of acute cerebral infarction 5 months after surgery,while the remaining 10 patients completed 12 months of follow-up.After receiving VSD treatment,all patients demonstrated a significant improvement in JOA scores,and there were no recurrences at the last follow-up.Conclusions The combination of expanding the intervertebral foramen approach for debridement with VSD treatment has been found to be both feasible and safe for treating primary thoracolumbar vertebral infection in elderly patients.The short-term follow-up results have shown clear effectiveness.

关 键 词：胸腰椎感染 椎间隙感染 扩大椎间孔入路 并发症 封闭负压引流 

分 类 号：R687.3[医药卫生—骨科学]