一期病灶清除植骨内固定治疗原发性椎间隙感染

One-stage debridement and fusion with instrumentation for treatment of spontaneous infection of intervertebral space

[目的]评估一期病灶清除、植骨并内固定治疗原发性胸腰椎间隙感染的外科疗效。[方法]回顾性分析1999年5月～2006年2月收治的18例原发性胸腰椎间隙感染的疗效，其中胸椎间隙3例、T12L1间隙2例、腰椎间隙10例、L5S1间隙3例。所有患者均无椎间盘手术病史及脊柱封闭或穿刺史，纳入诊断均靠术中术后病理确诊。全部病例均因保守治疗无效后行病灶清除、植骨并内固定术。术中病灶清除后局部应用抗生素，术后继续抗感染治疗。观察手术前后患者腰背部疼痛等症状缓解、神经功能恢复、脊柱矢状面平衡情况。[结果]所有患者术后症状明显缓解，体温正常。术前伴有脊髓神经损伤的6例患者术后神经功能均得到不同程度恢复。18例中仅有3例术后脓液细菌培养结果提示为金黄色葡萄球菌生长，其余均为无菌生长。所有病例术后标本病理结果均提示炎性改变，有中性粒细胞、浆细胞或巨噬细胞浸润，但未见结核性改变。随访13～45个月，平均26个月，感染均无复发，影像学检查提示：椎体序列良好，植骨节段均已骨性融合，无内固定物松动、断裂。术前误诊为“脊柱结核”8例。[结论]病灶彻底清除、植骨并坚强内固定有利于治疗原发性椎间隙感染，内植物的应用对感染无明显不良影响。

[ Objective ] To evaluate the outcome on patients with primary infection of intervertebral space of the thomcolumbar spine following combined one - stage debridement, strut grafting and internal fixation. [ Method ] From May 1999 to February 2006, 18 patients with spontaneous infection of intervertebral space were analyzed retrospoctively. These infections occurred at thoracic spine in 3 cases （16. 7% ）, thoracolumbar junction in 2 cases （11.1%）, lumbar spine in 10 cases （55. 5% ）, and lumbosacral junction in 3 eases （ 16. 7% ） . Their clinical data and outcome were studied. None of all had previous spinal surgery or spinal injection, and their diagnosis were confirmed by histopathology after surgery. All patients were treated by one - stage debridement, strut grafting and internal fixation after failure of nonsurgical treatment. Antibiotics was used following debridement in the infection sites, and was continued to be administered after surgery. Patients were evaluated before and after surgery in terms of pain, neurolagic level, sagittal spinal balance, and radiologic fusion. [ Result] Postoperatively, all patients experienced significant relief of symptoms, and no fever. Six patients showed improved neurological status （ at least one grade improvement on Frankel＇s functional classification） . Only 3 of 18 cases had a positive culture result that pathogen identified Staphylococcus aureus. Histological examination of the specimen after surgery revealed that inflammation occurred in all patients, but no evidence of tuberculosis. The period of follow - up ranged 13 to 45 months with a mean of 26 months. No evidence of recurrence or residual infection was observed in any patient. Postoperative radiological evaluation revealed that implants were stable, there was no phenomena of prosthesis subsidence, hook dislodgment and failure restoration of spinal segments height. Solid bony fusion was obtained in all patients. Eight patients were misdiagnosed for spinal tuberculosis. [ Conclusion ] One - stage eradication of the infection, strut grafting and internal fixation are effective treatments for primary infection of intervertebral space. The presence of the instrumentations at the site of infection has no negative influence on the course of infection healing.