经皮椎弓根内固定结合病灶内化疗治疗椎间隙感染探讨

Percutaneous pedicle screw combined with local chemotherapy in treatment of infection of intervertebral space

目的探讨经皮椎弓根螺钉内固定结合病灶内局部化疗治疗椎间隙感染的疗效。方法回顾2007年4月--2013年6月，采用经皮椎弓根内固定结合病灶内局部药物治疗的方法治疗椎间隙感染6例，其中男2例，女4例；年龄47—85岁，平均67岁。病变节段胸椎2例，胸腰段1例，腰椎3例。1例合并神经损伤，按Franke分级为C级。2例患者涉及单间隙两个椎体，4例患者涉及3个椎体2个间隙。术中局部应用抗生素冲洗，术后继续灌洗和抗感染治疗。观察患者手术前后腰背部疼痛等症状缓解、神经功能恢复、脊柱失状面平衡情况。结果随访5—52个月，平均13个月。5例患者痊愈，血沉正常，疼痛消失，恢复正常生活；1例患者病情改善，血沉及CRP持续下降，疼痛明显缓解。1例神经损伤患者Frankel分级：C级恢复至E级。随访期内，未出现椎弓根钉松动断裂现象。结论经皮椎弓根螺钉内固定结合病灶内化疗创伤小、出血少、恢复快，是治疗椎间隙感染有效的方法之一，内植物的应用对感染无明显不良影响。

Objective To assess the clinical efficiency of percutaneous pedicle screw combined with local chemotherapy in the surgical treatment of infection of intervertebral space. Methods From April 2007 to June 2013,6 advanced in- fection of intervertebral space patients were treated by percutaneous pedicle screw combined with local chemotherapy. A- mong them, there were 2 males and 4 females. Their ages ranged from 47 to 85 years, with an average of 67 years. The le- sion ranged from T4 to LS, with 2 in thoracic, 1 in thoracolumbar and 3 in lumbar. The level of the lesion were 2 for two vertebrae and 4 for three vertebrae. 1 cases were complicated with paraplegia with Frankel C. Antibiotics was used follow- ing debridement in the infection sites, and was continued to be administered after surgery. Patients were evaluated before and after surgery in terms of pain, neurologic leve, sagittal spinal balance, and radiologic fusion. Results All cases were followed up for an average of 13months（ range 5 -53 months）. 5 patients were cured and 1 patients were improved. No pedicle screw and rods losse and fracture occurred to the end of follow - up. Conclusion Percutaneous pedicle screws combined with local chemotherapy is one of method to treat infection of intervertebral space,which has some advantages including fewer traumas, less blood lose and better recovery from operation. The presence of the instrumentations at the site of infection has no negative influence on the course of infection healing.