腰椎术后椎间隙感染的原因分析及治疗策略

Postoperative Discitis of Lumbar:Etiology and Treatment Strategies

目的:分析发生椎间盘感染的原因,描述腰椎术后椎间隙感染的治疗策略。方法:回顾分析2003年1月～2011年5月收治的9例腰椎术后椎间隙感染患者的临床资料、治疗策略、ODI评分,并将腰椎术后椎间盘感染分为有明确原因类、无明显原因类,并按Macnab标准评定疗效。结果:7例发生在术后1周～1个月内、2例分别发生在术后5个月、术后1年。其中找到明确原因者4例:术前患有过敏性皮炎1例、术前糖尿病漏诊1例、无菌操作不严格2例;未找到明显原因5例。本组9例患者保守治疗7例、手术治疗2例;平均随访44.6个月(1～96个月),终末期随访时ODI评分为27.0(12～36),较治疗前的83.2(68～96)显著改善(P<0.05)。优6例,良2例,可1例,优良率88.9%。结论:术中谨慎操作及做好围手术期处理,将明显降低术后椎间盘感染的发生率;在积极运用抗生素的情况下,绝大多数椎间盘感染患者经过保守治疗可以获得满意疗效。

Objective t To identify the cause of postoperative discitis of lumbar and to describe its treatment strategies. Methods; A retrospective study on clinical data, treatment and ODI score of nine patients with postoperative discitis of lumbar during Janury 2003 ~ May 2011 was done and postoperative discitis of lumbar were classified into two categories： with or without exact cause. The outcome was evaluated according to Macnab standard. Results; There were seven postoperative discitis which took place during one week to one month and two patients at five months or one year after operation. Of which four patients was found the exact cause, including one atopic dermatitis, one patient missed diagnosis of diabetes and two without strict management of antiseptic, and the other was not found the exact cause. There were seven patient taking conservative therapy, only two receiving operation. All patients after second treatment were followed-up44.6 months （range, 1-96 months）, whose ODI were significantly declined from 83.2 （68-96）to 27.0 （12-36）（P 〈0.05）. There were 6 excellent, 2 fairly good, 1 mild, and the rate of good outcome was up to 88.9%. Conclusion： The incidence of postoperative discitis will be decrease by careful manipulate during and peri-operation. Most of postoperative discitis of lumbar can get good outcome by conservative therapy companied with antibiotic.