病灶清除+万古霉素硫酸钙骨粉治疗腰椎间隙感染

Treatment of patients with lumbar intervertebral space infection with debridement and calcium sulfate bone powder combined with vancomycin

目的探讨病灶清除+万古霉素硫酸钙骨粉治疗腰椎间隙感染的临床疗效。方法采用病灶清除+万古霉素硫酸钙骨粉治疗15例原发性和继发性腰椎间隙感染患者,观察术后不同时间ESR、CRP水平、疼痛VAS评分及JOA评分的变化。结果患者均获得随访,时间12～36(24. 7±6. 4)个月。患者均获得骨性融合,融合时间3～6(4. 6±1. 2)个月。术后CRP下降速度较ESR快,ESR于术后6个月、CRP于术后2周恢复到正常范围。单因素重复测量的方差分析显示,VAS评分术后1、3、6、12个月逐渐降低,各时间段比较差异均有统计学意义(P <0. 05,P <0. 01)。JOA评分术后1、3、6个月逐渐提高,各时间段比较差异均有统计学意义(P <0. 01),术后12个月与术后6个月比较差异无统计学意义(P=0. 189)。JOA改善率术后12个月为85. 0%±2. 59%,优良率为14/15。除1例马尾神经损伤外无其他并发症。随访期间无感染复发。结论病灶清除+万古霉素硫酸钙骨粉治疗腰椎间隙感染,能够迅速缓解疼痛,病灶一期愈合,显著缩短病程和住院时间,是治疗椎间隙感染的有效手段。

Objective To investigate the clinical effect on lumbar intervertebral space infection treated by debridement and calcium sulfate bone powder combined with vancomycin. Methods Fifteen patients with primary or secondary lumbar intervertebral space infection were treated by debridement and calcium sulfate bone powder combined with vancomycin therapy. Changes in ESR, CRP, pain VAS and JOA were statistically analyzed. Results All the patients were followed up for 12~36（24.7±6.4）months.Bony fusion was noted in all patients. The length of fusion time was 3~6（4.6±1.2）months. CRP returned to normal was more quickly than ESR after surgery. The needed time decreased to normal range were 6 months and 2 weeks, respectively. Single factor analysis of variance of repeated measurements showed that VAS at 1,3,6, and 12 months after operation decreased gradually（ P〈0.05,P〈0.01 ）. The JOA scores at 1,3 and 6 months after operation increased gradually（ P 〈0.01）,but the JOA scores at 12 months after operation was closed to that after 6 months（ P =0.189）. The average improvement rates of JOA scores after 12 months was 85.0%±2.59%, excellent-good rate was 14/15.There were no complications except one case of cauda equina nerve injury. No infection or recurrence occurred during follow-up. Conclusions It is an effective method for lumbar intervertebral discitis patients treated by debridement and calcium sulfate bone powder combined with vancomycin, with the characters of relieving pain rapidly,one stage fusion,shorter course of illness and hospital stay.