犬椎间隙感染治疗的实验研究

The experimental study of anterior autografting and internal fixation in treatment of canine pyogenic discitis

目的探讨椎间隙感染前路病灶清除一期植骨内固定的可行性、安全性及疗效和病理转归。方法犬腰椎间隙内注射金黄色葡萄球菌建立椎间隙感染模型。监测肛温、ESR、CRP;术后2周摄腰椎正侧位X线片和MRI,证实椎间隙感染模型成功建立。32只建模成功的犬随机均分为4组,A组:抗生素治疗;B组:抗生素治疗+前路病灶清除;C组:抗生素治疗+前路病灶清除+椎间植骨;D组:抗生素治疗+前路病灶清除+前路椎间植骨+钢板内固定。治疗后3d及1、2、3周测肛温、ESR、CRP;12周摄X线片后处死,取椎间隙组织病理学检查和培养。结果A组:治疗3周后肛温、ESR及CRP下降缓慢,12周内死亡3只,存活5只未发现椎体间融合。B、C、D3组与A组比较:3周后肛温、ESR、CRP均下降迅速,差异有显著性(P<0.05)。观察12周感染无复发,但B、C组出现脊柱后凸畸形各1只。12周后D组椎体间融合6只,与A、B、C组相比融合率升高(P<0.05),无脊柱畸形发生和感染复发。结论前路手术可彻底清除犬椎间隙感染病灶,一期植骨内固定无感染复发,融合率高,病理转归佳。

Objective To study the feasibility, security, the result of the treatment and pathology of one-stage anterior interbody autografting and internal fixation in pyogenic discitis. Methods Staphylococcus aureus was injected into canine intervertebral space. Pyogenic discitis model were successfully established that were testified by the check-ups of temperature, ESR, CRP , X-ray and MRI. As soon as pyogenic discitis model were successfully established, 32 models were divided into four groups by random, group A ： antibiotic treatment, group B ： antibiotic treatment and anterior debfidement, group C： antibiotic treatment, anterior debridement and autografting group D： antibiotic treatment, anterior debridement, autografting and internal fixation. The temperature, ESR and CRP were tested after the models were treated 3 days, 1 week, 2 weeks and 3 weeks. All the survive canines were taken X-ray test in 12 weeks and then sacrificed, and the disc spaces tissues were tested by pathology and germicuhure. Results The temperature, ESR and CRP of group A did not normalize within three weeks＇ treatment. 3 canines died and without bone fusion in the 5 survive canines 12 weeks late. Compared with group A, group B, C, D ： temperature, ESR and CRP normalized within 2-3 weeks （P 〈 0. 05 ）. Without canines dying and infection reoccurrence in 12 weeks, but both group B and group C occurred a kyphosis. Group D bone fusion were found in 6 canines and the bone fusion rate was significant higher than group A, B, C （ P 〈 0. 05 ） and without kyphosis and infection reoccurrence. Conclusions The anterior debridement can radical debride the infection tissues. One-stage anterior interbody autografting and internal fixation in pyogenic discitis improve the bone fusion rate without infection reoccurrence and prevent kyphosis occur.