单纯后路病灶清除椎间植骨内固定治疗成人非特异性腰椎间隙感染

Debridement and instrumented interbody fusion through posterior approach only for non-specific lumbar intervertebral infection in adult

[目的]评价单纯经后路病灶清除、椎体间植骨、钉棒系统内固定治疗成人非特异性腰椎间隙感染的临床疗效。[方法]回顾性分析中南大学湘雅医院脊柱外科2014年9月~2016年6月收治的非特异性腰椎间隙感染患者20例,男11例,女9例;年龄33~56岁,平均37.5岁。其中单一间隙感染15例,多间隙感染5例,CT或MRI显示所有患者病灶有不同程度的骨质破坏。术前给予2周以上的广谱抗生素治疗,均行单纯经后路病灶清除椎间植骨融合内固定术,术中留取病灶组织标本进行细菌培养及病理学检査。[结果]所有患者均顺利接受手术,无严重手术并发症,切口皆甲级愈合。7例为金黄色葡萄球菌,3例为表皮样葡萄球菌,10例细菌培养结果为阴性。所有病例术后随访6~18个月,平均(11.70±3.67)个月。术后所有患者症状明显缓解,体温恢复正常。VAS评分由术前(6.25±1.25)显著减少至术后2周(1.00±0.65),差异有统计学意义(P<0.05)。ESR及CRP术后3~9个月恢复至正常水平。至末次随访时,植骨融合率100%,无感染复发病例。ASIA评级由术前C级2例,D级10例,E级8例,改进至末次随访时,D级1例,E级19例,不同时间点间差异有统计学意义(P<0.05)。[结论]单纯经后路病灶清除、椎体间植骨、钉棒系统内固定术可有效地治疗非特异性椎间隙感染。

[Objective] To evaluate the clinical outcomes of debridement and instrumented interbody fusion for non-specific lumbar intervertebral infection in the adult. [Methods] A retrospective study was done on 20 patients who received surgical treatment for non-specific lumbar intervertebral infection in our department from September 2014 to June 2016. Of them, 13 males and 10 females aged 33 to 56 years with an average of 37.5 years. In term of number of intervertebral space involved, 17 patients had only a single lumbar intervertebral space affected, while the remaining 6 patients suffered from multiple lumbar intervertebral infections, associated with different extend of bony destruction on CT or MIR images. Subsequent to administration of broad-spectrum antibiotics for more than 2 weeks, all the 20 patients received a thorough debridement combined with instrumented interbody fusion. During operation, the tissue samples of involved discs were collected for bacterial culture and pathological examination. [Results] All patients had operation performed successfully with incision healing by first intention, without serious complications. In term of bacteriology, 7 patients had staphylococcus aureus checked out, 3 were proven staphylococcus epidermal and the remaining 10 had negative culture. The 20 patients were followed up from 6 to 18 months with an average of11.70±3.67 months. After operation the symptoms, including pain and fever relieved significantly in all of them. The VAS significantly decreased from（6.25±1.15） preoperatively to（1.00±0.65） at 2 weeks after operation with a statistical difference between the two time points（P〈0.05）. The erythrocyte sedimentation rate and C-reaction protein return to the normal levels from 3 to 9 months postoperatively. At the latest follow up, no recurrent infection happened in anyone of the patients, whereas bony fusion achieved in all of them. In addition, the ASIA scales considerably enhanced from Grade C in 2, Grade D in 10 and Grade E in 8 preoperatively to Grade D in 1 and Grade E 19 patients at the latest follow up（P〈0.05）. [Conclusion] This surgical technique, debridement combined with instrumented interbody fusion through posterior approach only, is effective and reliable for non-specific lumbar intervertebral infection.