一期前路病灶清除植骨内固定术治疗颈椎化脓性感染

Anterior debridement,graft and instrument for the treatment of cervical pyogenic osteomyelitis

目的探讨前路病灶清除并取自体骨植骨钛板固定术治疗颈椎化脓性感染的疗效。方法回顾性研究2008年1月至2013年1月收治的12例颈椎椎体化脓性感染患者,其中男8例,女4例;年龄为41～71岁,平均56.7岁。所有患者均有较为严重的颈肩部疼痛,4例伴神经功能损害;术前疼痛视觉模拟量表（visual analogue scale,VAS）评分为7～10分,平均（8.1±1.5）分;按照日本骨科协会（Japanese Orthopaedic Association,JOA）颈椎评分标准评分为7～11分,平均（9.2±1.5）分。所有患者诊断明确,均行手术治疗,术后局部行闭式冲洗并结合敏感抗生素静脉治疗不少于6周。结果患者获得12～24个月的随访,平均18.5个月,所有患者术后症状明显改善,末次随访复查植骨融合,无内固定物失败。所有患者感染病灶无复发,神经功能均完全恢复正常。无严重并发症出现,仅有1例出现伤口皮下积液故延迟1周愈合。结论一期前路病灶清除植骨融合内固定治疗颈椎化脓性感染,结合后期规范的敏感抗生素治疗,能够取得良好的效果。

Objective To discuss the efficacy of one-stage debridement, autologous graft and instru-ment via the anterior approach for the treatment of cervical pyogenic osteomyelitis. Methods A retrospectiveanalysis was carried out on 12 cases of cervical pyogenic osteomyelitis admitted to our hospital from January2008 to January 2013, including 8 males and 4 females, aged 41-71 years old（mean 56.7 years old）. All casessuffered from severe neck and shoulder pain. The preoperative scores of Visual Analogue Scale（VAS） for painwere 7-10（everage, 8.1±1.5） points. Four cases had nerve function deficit, and the Japanese Orthopaedic Asso-ciation（JOA） scores for cervical vertebrae were 7-11（everage, 9.2±1.5） point. All cases were explicitly diag-nosed and received wide-spectrum anti-infective therapy for 1 week before the operation. Emergency operationwas employed for patients with nerve function deficit. All patients with surgery underwent closed wash for 7-10 days and anti-infective therapy for 6 weeks at least after surgery. Results Neck and shoulder pain was obvious-ly alleviated 1 week after the operation, and normal body temperature was restored. The laboratory indicatorswere also gradually restored to normal. The follow-up lasted for 12-24 months with an average of 18.5 months.The graft was successfully fused in the last follow-up in all cases, and no failure of internal fixation occurred.There was no recurrence and the nerve function was completely restored in all cases. No severe complicationswere found in this group. Conclusion One-stage debridement, autologous graft and instrument via the anteriorapproach can achieve good curative results in cervical pyogenic osteomyelitis when supplementing with patho-gen-specific antibiotic therapy.