腰椎后路病灶清除植骨融合内固定治疗腰椎间隙非特异性感染的疗效分析

Treatment of non-specific lumbar intervertebral infection by posterior lumbar approach with debridement, grafting fusion and internal fixation

目的探讨后入路腰椎病灶清除植骨融合内固定治疗腰椎间隙非特异性感染的疗效。方法回顾性分析本院2014年5月至2018年5月收治的腰椎间隙感染行后入路病灶清除植骨融合内固定的病例23例,其中,男10例,女13例,年龄25~75岁,平均年龄49岁,病变节段L2/3 3例,L3/4 4例,L4/5 11例,L5/S1 5例。所有患者行后入路腰椎病灶清除植骨融合内固定术,双侧放置引流管各1根,术后充分引流,引流量低于10 mL时拔除引流,行抗感染治疗,静脉抗生素3周,口服抗生素4~6周。结果所有23例患者手术均顺利完成,手术时间平均(170±26.3)min,术中失血量150~450 mL,平均(320±68)mL。细菌培养结果提示12例患者为阴性,4例为金黄色葡萄球菌,3例为大肠埃希菌,2例为铜绿假单胞杆菌,2例为表皮葡萄球菌。引流管拔除的时间为5~10 d,平均为(7±2.8) d。术后随访6~24个月,平均随访19个月,22例患者腰背部疼痛症状缓解明显,椎间隙植骨一期骨性融合,1例患者术后2个月病灶控制不理想经再次手术后完全恢复。所有患者术前血沉和C反应蛋白均有不同程度升高,血沉平均(59±25) mm/h,C反应蛋白平均(42±20)mg/L,末次随访时均降为正常范围。术前VAS评分平均(6.3±0.6)分,末次随访平均(1.1±0.7)分,与术前比较差异有统计学意义(P<0.05)。结论后路病灶清除植骨融合内固定能有效治疗腰椎间隙非特异性感染。

Objective To investigate the effect of posterior lumbar approach with debridement,grafting fusion and internal fixation in treatment of non-specific lumbar intervertebral infection. Methods A retrospective analysis was performed on 23 cases of lumbar intervertebral infection treated in our hospital from May 2014 to May 2018 by posterior approach with debridement,grafting fusion and internal fixation. Among them, there were 10 males and 13 females, aged from 25 to 75 years, with an average age of 49 years, including 3 cases at L2/3, 4 at L3/4, 11 at L4/5, 5 at L5/S1. All the patients were treated by posterior lumbar approach with debridement, grafting fusion and internal fixation. Drainage tube was placed in the each side of lumbar, sufficient drainage was performed postoperatively, and drainage tube was removed when the drainage volume was less than 10 mL. Anti-infective therapy was routinely performed, intravenous antibiotics for 3 weeks, oral antibiotics for 4 to 6 weeks. Results All 23 patients were successfully operated on. The average operative time was (170±26.3) min, intraoperative blood loss was 150 ~ 450 mL, averaged (320±68) mL. The results of bacterial culture indicated that 12 patients were negative, 4 were staphylococcus aureus, 3 were escherichia coli, 2 were pseudomonas aeruginosa and 2 were staphylococcus epidermidis. Sufficient postoperative drainage was performed, and the extubation time was 5 ~ 10 days postoperatively, averaging (7±2.8) days. Postoperative follow-up was 6 ~ 24 months, with an average of 19 months. The pain symptoms of low back were significantly relieved in 22 patients, and primary bone fusion was achieved by intervertebral bone graft. The lesion control of one paitient was not ideal for two months after surgery and was completely recovered after another operation. Postoperatively, all patients experienced significant relief of low back pain. The VAS score averaged (6.3±0.6) before surgery and (1.1±0.7) at final follow-up(P<0.05). Conclusion The treatment of lumbar intervertebral infection with posterior lumbar approach with debridement, grafting fusion and internal fixation is an effective method for non-specific lumbar intervertebral infection.