一期病灶清除植骨内固定联合置管冲洗治疗原发性胸腰椎非特异性感染

One stage debridement and internal fixation of bone combined with drainage in treating non-specific primary thoracolumbar infection

目的观察一期病灶清除植骨内固定联合置管冲洗治疗原发性胸腰椎非特异性感染的临床疗效。方法回顾性分析2012年7月至2016年6月河北省胸科医院骨科收治的46例原发性胸腰椎非特异性感染患者的临床资料，其中，胸椎4例，胸一腰段椎体5例，腰椎椎体33例，腰骶段椎体4例；术前抗感染治疗时间为2～4周；手术均采用一期病灶清除植骨内固定联合置管冲洗术，术后冲洗时间为3～28d，平均（14．O±4．3）d。分析患者的疼痛缓解情况、感染控制情况、术后下床时间、神经功能恢复情况、植骨融合情况，对疗效进行评价。结果本组46例患者术中标本细菌培养阳性15例，阳性率为32．6％。患者术后3周应用疼痛视觉模拟量表（VAS）评分平均为（2．59±0．20）分，与术前的（7．09±0．25）分比较，差异有统计学意义（t=11．35，P〈O．05）；术后3周血红细胞沉降率（ESR）为（43．30±3．13）mm／1h，术前ESR为（65．98±4．56）mm／1h，差异有统计学意义（t=5．45，P〈0．05）；术后3周D反应蛋白（CRP）为（17．15±1．10）mg／L，术前CRP为（34．54±2．43）mg／L，差异有统计学意义（t=9．63，P〈O．05）。二次手术患者1例，二次手术率为2．2％（1／46）。术后患者佩戴支具下床时间5～21d，平均（12．6±4．7）d。12例术前并发脊髓神经功能障碍患者，按美国脊柱损伤协会（ASIA）神经功能分级标准，2例由术前A级分别恢复至B级和C级；2例由术前B级分别恢复至C级和D级；8例由术前C级恢复至D级3例，E级5例。46例患者椎间植骨块融合时间为3～12个月，平均（7．6±1．8）个月；按照植骨融合标准，其中优35例、良9例、可2例，优良率为95．7％（44／46）。结论对有手术适应证患者实施一期病灶清除植骨内固定联合置管冲洗治疗是安全、可行的，具有快速控制感染、解除患者疼痛、恢复神经功能、早期下床活动等优势，是治疗脊柱非特异性感染可选择的有效方法。

Objective To investigate the effect and value of one stage debridement and internal fixation of bone combined with drainage on treating non specific primary thoracolumbar infection. Methods The pre- and post-operation clinical data were collected from 46 patients with primary thoracolumbar non-specific infection admit- ted in the department of orthopedics of the Chest Hospital of Hebei Province from July 2012 to June 2016. Those patients included 4 cases with infection in thoracic, 5 cases in thoracolumbar, 33 cases in lumbar, and 4 cases in lumbosacral. All patients received anti-inflammatory treatment for 2 to 4 weeks before operation. One stage debridement and internal fixation of bone combined with drainage was conducted. The average drainage time after operation was （14.0±4.3） days, ranged from 3 to 28 days. Pain relief, infection control situation, time to getting the patient out of bed after surgery, recovery of neurological function, and bone graft fusion were observed, and the efficacy was evaluated. Results Among the 46 cases in this study, 15 cases were bacterial culture positive, with a positive rate of 32.6%. The visual analogue scale （VAS） score at the third week was （2.59±0.20） ; compared with preoperative （ 7.09 ± 0.25）, the difference was statistically significant （t = 11.35, P〈0. 05）. The erythrocyte sedimentation rate （ESR） at the third week after operation was （43.30± 3.13） ram/1 h; compared with preoperative （65.98±4.56 mm/1 h）, the difference was statistically significant （t=5.45, P〈0.05）. The （reactive protein （CRP） at the third week after operation was （17.15 ± 1.10） mg/L; compared with preoperative （34.54±2.43 mg/L）, the difference was statistically significant （t=9.63, P〈0.05）. One case received a second surgery, and the second surgery rate was 2.2% （1/46）. Postoperative, the mean time of patients wearing a brace out of bed was （12.6± 4.7） days, ranged from 5 to 21 days. Among the 12 patients with preoperative spinal cord nerve dysfunction, American Spinal Injury Association （ASIA） grade recovered form Grade A to Grade B in 1 case, and form A to C in 1 case, from B to C in 1 case, from B to D in 1 case, from C to D in 3 cases, and from C to E in 5 cases. The fusion time of interbody bone graft ranged from 3 to 12 months in 46 cases, and the mean fusion time was （7.6 ± 1.8） months. According to the fusion standards, 35 cases were excellent, 9 were better, and 2 were good, resulting in an excellent and better rate of 95.7% （44/46）. Conclusion For patients with non specific primary thoracolumbar infection who has surgical indication, one stage debridement and internal fixation of bone combined with drainage is safe and feasible. It has the advantages of rapid infection control, pain relief, neurological recovery, and early ambu- lation and is an effective method in treating： non-specific primary thoracolumbar infection.