一期前路病灶清除联合后路固定治疗颈椎椎间隙感染

One-stage anterior debridement combined with posterior pedicle screw fixation to treat cervical vertebral space infection

目的探讨一期前路病灶清除联合后路椎弓根钉棒固定治疗颈椎椎间隙感染的疗效。方法2010年6月至2016年6月因颈椎椎间隙感染行一期前路病灶清除联合后路椎弓根钉棒固定术患者28例，男19例，女9例；年龄45～74岁，平均（58．0±14．5）岁。21例（75％）为自发感染，其中6例合并糖尿病，15例年龄超过60岁；余7例（25％）为颈椎射频消融术后发生椎间隙感染。所有患者均排除结核、布氏菌感染。所有患者术前均行血液学检查，重点记录白细胞计数、红细胞沉降率及C-反应蛋白。术前根据血液细菌培养及药敏试验结果应用抗生素，手术后继续静脉应用抗生素辅助治疗，并根据红细胞沉降率、C-反应蛋白复查结果指导抗生素应用，记录抗生素应用时间。记录手术时间、术中出血量，并分别在术前和术后3、6及12个月进行JOA评分，观察手术前后手术节段颈椎前凸Cobb角的变化。结果28例患者均顺利完成手术，手术时间130-225min，平均（145．5±12．7）min。术中出血量为40-100ml，平均（67±35．2）ml。切口均一期愈合。28例患者抗生素应用时间21-87d，平均（30．8±8．7）d，随访期间未发现感染复燃的患者。JOA评分由术前平均（11.3±1．2）分上升至术后3个月平均（14．9±1．96）分、术后6个月平均（15．1±1．55）分及术后1年平均（16．5±0．48）分，术后JOA评分均较术前明显升高。术后颈椎手术节段前凸Cobb角较术前无明显变化，随访期间亦无明显丢失。所有病例在术后1年时植骨均融合良好。结论一期前路病灶清除联合后路椎弓根钉棒固定治疗颈椎椎间隙感染及其引起的颈椎不稳及神经功能损害是安全、有效的方法，为颈椎椎间隙感染的治疗提供了新的思路与方法。

Objective To evaluate the efficacy of one stage anterior debridement combined with posterior pedicle screw fixation in the treatment of cervical intervertebral space infection. Methods From June 2010 to June 2016, 28 cases were fixed by anterior debridement combined with the posterior vertebral pedicle screws for the cervical intervertebral space infection, 19 males and 9 females. The average age was 45-74 years （58±14.5 years old）. 21 cases （75%） were spontaneous infection, of which 6 cases were diabetes mellitus, 15 cases were over 60 years old. The remaining 7 cases （25%） were intervertebral space infection after radiofrequency ablation of the cervical spine. All patients were excluded from tuberculosis and Brucella infection. All patients underwent hematological examination, with emphasis on WBC, ESP and CRP. All patients received JOA score before operation, applied antibiotic according to blood cuhure and drug sensitive test. All patients underwent one stage anterior debridement combined with posterior pedicle screw fixation, and the operative time and bleeding volume were recorded. After the operation, intravenous antibiotic therapy was continued, and the application of antibiotics was guided according to the results of ESP and CRP, and the time for the application of antibiotics was recorded. Follow up was performed at 3 months, 6 months and 1 years after operation respectively. The JOA score and postoperative cervical lordosis Cobb angle were recorded. Results All operations were successfully completed in this group. The operation time was 130-225min, with an average of 145.5±12.7 rain. The intraoperative blood loss was 40-100 ml, with an average of 67±35.2 ml. The incision was healed in one stage. The time of application of antibiotics in 28 patients was 21-87 days, with an average of 30.8±8.7 days. The longest application time of antibiotics was 87 days, and no relapse was found during follow-up. The postoperative JOA score increased from 11.3±1.2 to three months 14.9±1.96 postoperatively and 6 months 15.1±1.55 and 1 years 16.5±0.48 after operation. The JOA score was significantly higher than that before operation. No significant loss and change of the Cobb angle in the cervical spine surgery were found. All cases had good bone graft fusion at 1 years. Conclusion One stage anterior debridement combined with posterior pedicle screw fixation is a safe and effective method for the treatment of cervical vertebra instability and nerve function injury caused by cervical intervertebral space infection. It provides a new way for the treatment of cervical intervertebral space intection.