病灶清除植骨融合治疗腰椎术后迟发性椎间隙感染

Clinical Effect of Anterior Debridement,Bone Graft Fusion in Treatment Late-developing Intervertebral Infection

目的观察采用前路病灶清除自体髂骨植骨融合治疗腰椎内固定术后迟发性椎间隙感染的临床疗效。方法2006年7月至2011年3月,收治11例腰椎术后迟发性感染患者。男9例,女2例;年龄35～68岁,平均48.5岁。腰椎间盘摘除或腰椎内固定术后13～176周出现感染,平均47周。全部病例采用前路病灶清除、椎间植骨融合术,其中1例取出后路内固定物,骨质疏松严重,未行前路内固定。结果残余椎间盘细菌培养结果显示,微球菌2例,短杆菌1例,大肠埃希氏菌4例,阴性4例。术后切口均Ⅰ期愈合。11例均获随访,随访时间18～49个月,平均35.6个月。术后白细胞计数、红细胞沉降率及C反应蛋白均下降,并逐渐恢复正常。末次随访时疼痛视觉模拟评分为(2±1)分,与术前(9±2)分比较差异有统计学意义(P<0.05)。结论前路病灶清除自体髂骨植骨融合是治疗腰椎术后迟发性椎间隙感染的有效方法之一,能迅速缓解腰痛症状,术野清晰,病灶清除彻底,术后恢复良好,临床疗效确切。

Objective To explore the clinical outcome with anterior radical debridement,bone graft with internal fixationlin of treating late-developing intervertebral infection. Methods Between July 2006 and March 2011,11 cases of late-developing intervertebral infection were treated by anterior radical dehridement,autologous ilium bone graft with internal fixation in this institution. There were 9 males and 2 female. The age of patients ranged from 35 to 68 years with the mean of 48.5 years. The mean time from operation to infection was 47 weeks （range, 134 176 weeks）. Of all 11 cases, 10 cases underwent anterior radical debridement,autologous ilium bone graft with internal fixation. 1 case was treated with internal fixation removal ,debridement ,autologous ilium bone graft without anterior internal fix- ation because of severe osteoporosis. Results Bacterial cultures revealed 2 patients had micrococcus, 1 patient had Brevibacterium,4 patients had Escherichia coil,negative in 4 cases. All the wounds healed. All the case were followed up for 18~49 months （ average 35. 6 months）. Postoperative leukocyte count,erythrocyte sedimentation rate,and C reactive protein were decreased gradually and returned normal eventually. The mean VAS score of back pain was im- proved from （9 --4-_ 2） preoperatively to （2 ~＋ 1 ） at the final visit, the difference was statistically significant （P ~ 0. 05）. Conclusion Anterior radical debridement,autologous ilium bone graft with internal fixation is a safe and effective method for late developing Intervertebral infection. It has the advantages of alleviating symptoms rapidly,clear vision- field,completely debridement ,good recovery after operation. The clinical effect is excellent.