腰椎间盘术后椎间隙感染的后路手术治疗

Posterior Surgical Treatment for Postoperative Lumbar Intervertebral Discitis

目的:探讨腰椎间盘术后椎间隙感染行后路手术治疗的疗效。方法对1997年1月-2012年12月收治的25例腰椎手术后椎间隙感染病人进行回顾性分析,分析其临床表现、实验室检查、诊断要点和治疗方法。25例中,保守治疗10例,后路手术治疗15例,其中行病灶清除减压术10例,5例伴腰椎不稳的患者行病灶清除并植骨内固定术。结果:所有患者均获痊愈,后路手术治疗的患者症状缓解时间为1～2周,卧床时间为2～5周,术后3～4个月X线片显示植骨融合,内固定位置良好;保守治疗的患者症状缓解时间为2～3个月,卧床时间为2～5个月。结论:腰椎间盘术后椎间隙感染行保守治疗症状持续时间和疗程较长,行后路手术治疗可以较快减轻症状,缩短疗程,是更为有效的治疗手段。

Objective：To evaluate the therapeutic effect of posterior surgical treatment for postoperative lumbar interverte- bral discitis. Methods： All 25 cases of postoperative lumbar intervertebral discitis were retrospectively analyzed from Januar y 1997 to November 2012, including its symptom, sign, laboratory examination, diagnosis, and treatment method. Among them, 10 cases were cured with conservative method, and the other 15 cases were treated surgically through posterior ap- proach. Debridement and decompression were undergone and 5 cases with lumbar instability were fused by bone graft im- planting and pedicle internal fixation. Results： All patients were recovered. The symptom continued 1 to 2 weeks and the time resting in bed lasted 2 to 5 weeks in the surgical group. X-ray showed that lumbar spine had been fused 3 to 4 months postoperatively. In the conservative group, the symptom continued 2 to 3 months and the time resting in bed lasted 2 to 5 months. Conclusion：The time for symptom suffering and resting in bed is longer in the conservative group than in the oper ating group. It is more effective to treat postoperative lumbar intervertebral discitis by operation.