硫酸钙骨粉混合抗生素钛笼植入治疗胸椎化脓性脊椎炎骨缺损

Implantation of calcium sulfate powder and antibiotics for the treatment of suppurative spondyfitis of the thoracic vertebra

背景:关于椎间隙感染的治疗方案存在许多争议,在保守治疗方面,多数学者主张卧床制动、理疗,对症处理,同时应用大剂量抗生素控制感染,但有些学者对抗生素的应用存有异议。目的:探讨硫酸钙骨粉混合抗生素在胸椎化脓性脊柱炎治疗中的作用。设计、时间及地点:回顾性病例分析,病例来自2000-10/2008-08广东医学院附属医院骨科。对象:选择广东医学院附属医院骨科收治的胸椎化脓性脊椎炎患者24例,男9例,女15例;年龄42～71岁;病灶位于T6/7节段9例,T7/8节段6例,T8/9节段3例,T10/11节段4例,T6/8节段2例。24例患者中8例疼痛剧烈,不能忍受,背肌痉挛,被动体位,转侧困难,伴一侧或双侧下肢痛;11例伴食欲减退、消瘦;2例伴双下肢不全瘫,自主排尿困难;3例伴糖尿病。方法:全部患者均采取侧前方经胸腔病灶清除后,将填入混合有抗生素的硫酸钙骨粉的钛笼植入骨缺损区,两钉一棒内固定。术后大量应用抗生素及腰背部支具外固定。主要观察指标:JOA评分标准评价患者功能的恢复率,并观察血沉及骨性愈合情况。结果:24例患者全部获得随访,平均随访5.8年。1例患者没有恢复,其余23例均有明显恢复,恢复率30%～100%。血沉从术前平均(86.74±10.56)mm/h下降到术后5个月时的(26.40±5.42)mm/h。24例患者全部获得骨性融合,融合时间3～8个月。无手术直接相关的死亡及其他并发症,随访期间无感染复发。结论:将填入混合有抗生素的硫酸钙骨粉的钛笼植入胸椎病灶清除术后骨缺损区,结合两钉一棒内固定及腰背部支具外固定是治疗胸椎化脓性脊椎炎的有效方法。

BACKGROUND： Treatment prescription for intervertebral space infection is controversial. Conventionally, lying in bed, physical therapy, symptomatic therapy, and a large dosage of antibiotics were used frequently; however, the application of antibiotics was still controversial. OBJECTIVE： To explore the implantation of calcium sulfate powder combined with antibiotics for the treatment of suppurative spondyfitis of the thoracic vertebra. DESIGN, TIME AND SETTING： A retrospective case analysis was performed at Department of Orthopaedics, Affiliated Hospital of Guangdong Medical College from October 2000 to August 2008. PARTICIPANTS： A total of 24 patients with suppurative spondyfitis of the thoracic vertebra, including 9 males and 15 females and aging 42-71 years, were provided by Department of Orthopaedics, Affiliated Hospital of Guangdong Medical College. Suppurative spondyfitis of thoracic vertebra occurred on T6/7 （n=9）, T7,8 （n=6）, Ts-9 （n=3）, T10/11 （n=4）, and T6/8 （n=2）. Among all patients, 8 cases had severe pain, myospasm of dorsal muscles, passive position, difficulty of turning over, and lateral or bilateral melosalgia; 11 had anorexia and athrepsy; 2 had paresis of both lower extremities and difficulty of automatic micturition; 3 had diabetes mellitus. METHODS： After the 24 patients with suppurative spondyfitis of the thoracic vertebra received the cleaning operation on focus infection through latero-anterior thoracic cavity, the defect area of bone was inserted with titanium case filled with the calcium sulfate cement combined with antibiotics, and then the internal fixation and a plenty of antibiotics were applied after the operation. MAIN OUTCOME MEASURES： Recovery rate was evaluated using JOA assay, and blood sedimentation and bone healing were observed. RESULTS： All the 24 patients received the follow-up with the mean duration of 5.8 years. One case did not recovered, but other 23 patients recovered obviously. The recovery rate was 30%-100%. Blood sedimentation decreased from （86.74＋10.56） mm/h before operation to （26.40±5.42） mm/h at 5 months after operation. Bone fusion occurred on all 24 patients, and the time lasted for 3-8 months. Relative death, complications, and infection-induced relapse were not found during the following up. CONCLUSION： To insert the titanium case filled with the calcium sulfate cement combined with antibiotics into the defect area of bone created by the cleaning operation on focus infection and combine with the application of the internal fixation by one stick and two screw and the brace for back and lumbar is an effective therapy for treatment of suppurative spondyfitis of the thoracic vertebra.