化脓性革兰阴性杆菌性脊柱炎患者的手术治疗效果分析

Surgical curative effects of Gram-negative bacterial suppurative vertebral osteomyelitis： report of 13 cases

目的分析化脓性革兰阴性杆菌性脊柱炎（Gram-negative bacterial vertebral osteomyelitis，GNBVO）的手术治疗效果。方法收集2007年1月至2016年12月首都医科大学附属北京胸科医院诊断为化脓性GNBVO并行手术治疗的13例患者的临床资料，13例化脓性GNBVO患者均有感染史或高危感染因素（高龄、并发糖尿病、其他慢性感染、长期使用抗生素、免疫抑制剂等）；其中，感染大肠埃希菌9例，肺炎克雷伯杆菌2例，铜绿假单胞菌1例，阴沟肠杆菌1例。对手术前后痛觉视觉模拟评分（visual analogue scalescore，VAS）、白细胞计数（WBC）、中性粒细胞比率、血红细胞沉降率（ESR）、C-反应蛋白（CRP）等水平进行比较，同时观察末次随访（第12个月末）时术后患者病椎的骨性融合、治愈等情况。计数资料以“x±s”表示，采用t检验，以P〈0．05为差异有统计学意义。结果13例化脓性GNBVO患者末次随访VAS评分[（1．46±0．78）分]、wBC[（7．14±1．20）×10^9／L]、中性粒细胞比率（0．69±0．03）、ESR[（10．29±4．82）mm／1h]、CRP[（3．57±2．07）mg／L]较术前[分别为（7．38±1．19）分、（15．93±2．82）×10^9／L、（0．08±0．02）、（72．71±18．45）mm／1h、（53．20±18．25）mg／L]均明显改善（t值分别为33．34、8．99、6．40、9．21、6．67，P值均=0．000）。13例患者经敏感抗生素联合手术治疗12～16周后均治愈，其中1例肺炎克雷伯杆菌感染患者术后2周因刀口破溃，行3次负压封闭引流治疗后刀口延期愈合。全部患者末次随访时均获得骨性融合，无复发。结论化脓性GNBVO患者经过敏感抗生素联合手术治疗12～16周后，VAS评分、wBC、中性粒细胞、ESR、CRP水平均较术前明显改善，可达到骨性融合的治愈目的。

Objective To explore the surgical curative effect of Gram-negative bacterial vertebral osteomyelitis （GNB VO）. Methods Between Jan 2007 and Dec 2016, 13 GNB VO patients underwent surgery in Beijing Chest Hospital were analyzed in this study. All of the 13 cases had high risk factors or history of infection. The pathogenic bacteria include 9 cases of escherichia coli, 2 cases of klebsiella pneumoniae, 1 case of pseudomonas aeruginosa and 1 case of enterobacter cloacae. The changes of visual analogue scale score （VAS）, WBC, neutrophile granulocytc, ESR, CRP before and after surgery were evaluated. Bone fusion at 12 months follow-up has also been observed. The paired samples t test was performed to assess the differences,which were considered statistically significant at P〈0.05. Results The VAS, WBC, neutrophile granulocyte, ESR, CRP （（1.46±0.78） score, （7.14±1.20））〈 10^9/L, 0.69±0.03, （10.29±4.82） mm/1 h, （3.57±2.07） mg/L） at the final follow up were significantly improved than that before surgery （（7.38±1.19） score, （15.93±2.82）〈 10^9/L, 0.80±0.02, （72.71± 18.45） mm/1 h, （53. 20±18. 25） mg/L） （t were 33.34, 8.99, 6.40, 9.21 and 6.67, respectively;Ps 0.000）. Thirteen patients who received sensitive antibiotic combined surgery were cured after 12-16 weeks treatment. One case with klebsiella pneumoniae infection which turned into fistula at 2 weeks after surgery, was cured after 3 timesvacuum sealing drainage dressing treatment. All cases had bone fused without recurrence at 12 months follow up. Conclusion The cases of GNB VO could be cured by combination of sensitive antibiotic and surgery, and the dura tion of sensitive antibiotic is no less than 12-16 weeks.