一期前路病灶清除植骨融合术治疗颈椎化脓性脊柱炎的临床效果  

Clinical efficacy of one-stage anterior debridement and bone graft fusion for the treatment of cervical pyogenic spondylodiscitis

作　　者：胡宇坤 甫拉提·买买提[1] 高书涛 蔡晓宇 盛伟斌[1] Hu Yukun;Maimaiti Fulati;Gao Shutao;Cai Xiaoyu;Sheng Weibin(Department of Spinal Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,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

出　　处：《中华外科杂志》2024年第9期870-877,共8页Chinese Journal of Surgery

基　　金：国家自然科学基金(82360257);新疆维吾尔自治区自然科学基金(2021D01D18);新疆维吾尔自治区科技创新领军人才项目(2023TSYCLJ0031);新疆医科大学第一附属医院青年科研启航项目(2023YFY-QKMS-06)。

摘　　要：目的探讨一期前路病灶清除植骨融合术治疗颈椎化脓性脊柱炎的可行性。方法本研究为回顾性病例系列研究。回顾性分析2015年1月至2020年1月新疆医科大学第一附属医院脊柱外科收治的23例颈椎化脓性感染患者的临床和影像学资料。男性14例,女性9例,年龄(51.9±12.8)岁(范围:26~82岁)。14例患者术前合并神经功能损害,美国脊髓损伤协会(ASIA)神经功能损伤分级A级1例,B级1例,C级5例,D级7例。患者均接受一期前路病灶清除植骨融合术治疗。记录手术时间、出血量、住院时间、病原微生物检测结果、植骨融合时间及手术并发症等情况。术后1、3、6、12个月随访时行影像学检查,测量C_(2~7)Cobb角和病变节段Cobb角,并监测血液感染指标。采用疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)和ASIA神经功能损伤分级评估临床疗效。手术前后数据的比较采用配对样本t检验、重复测量方差分析或广义估计方程。结果23例颈椎化脓性脊柱炎手术均顺利完成,手术时间(102.8±19.8)min(范围:60~140 min),出血量(84.4±40.2)ml(范围:30~160 ml),住院时间(17.4±6.0)d(范围:10~30 d)。14例患者血培养检出病原菌,9例未检出,阳性率为60.8%;19例灌洗液培养检出病原菌,4例未检出,阳性率为82.6%。患者术后均获得12个月以上随访,随访时间(19.0±5.9)个月(范围:12~36个月)。末次随访时,VAS由术前的(5.9±1.1)分降至(0.8±0.3)分;NDI由术前的(38.3±6.0)%降至(9.3±3.0)%,差异均有统计学意义(P值均<0.01);ASIA神经功能损伤分级均得到改善,除C级1例,D级2例外,其余患者均恢复至E级;C 2~7 Cobb角、病变节段Cobb角均得到矫正。白细胞计数、红细胞沉降率、C反应蛋白均恢复至正常水平。所有患者获得骨性融合,融合时间为(8.9±1.9)个月(范围:6~12个月)。2例糖尿病患者术后发生切口感染,其余患者未发生手术相关并发症。结论一期前路病灶清除植�Objective To investigate the efficacy of one-stage anterior debridement and bone graft fusion for the treatment of cervical pyogenic spondylodiscitis.Methods This is a retrospective case series study.Retrospective analysis of clinical data from 23 patients with cervical pyogenic spondylodiscitis treated with one-stage anterior approach debridement and bone graft fusion was performed in the Department of Spinal Surgery,the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2020.There were 14 males and 9 females,aged(51.9±12.8)years(range:26 to 82 years).Preoperatively,14 patients had neurological deficits,classified according to the American Spinal Injury Association(ASIA)impairment scale as follows:grade A in 1 case,grade B in 1 case,grade C in 5 cases,and grade D in 7 cases.All patients underwent the one-stage anterior debridement and fusion procedure.The surgical time,blood loss,hospital stay,fusion time,and surgical complications were documented.Clinical efficacy was assessed using the visual analogue scale(VAS),the neck disability index(NDI),and the ASIA impairment scale.Preoperative and postoperative data were compared using paired sample t tests,repeated measures analysis of variance,and generalized estimating equations.Results All the 23 patients underwent the operative procedures successfully.The operation time was(102.8±19.8)minutes(range:60 to 140 minutes),blood loss was(84.4±40.2)ml(range:30 to 160 ml),and the length of hospital stay was(17.4±6.0)days(range:10 to 30 days).Blood cultures were positive for the causative pathogen in 14 cases(60.8%positivity rate),while 9 cases had negative results.Irrigation fluid cultures yielded the causative pathogen in 19 cases(82.6%positivity rate),with 4 cases negative.All patients were followed up for more than 12 months,with a follow-up duration of(19.0±5.9)months(range:12 to 36 months).At the final follow-up,VAS improved from(5.9±1.1)points preoperatively to(0.8±0.3)points;NDI improved from(38.3±6.0)%preoperatively to(9.

关 键 词：脊柱炎 颈椎 化脓性脊柱炎 前路病灶清除植骨融合术 一期手术 临床疗效 

分 类 号：R687.3[医药卫生—骨科学]