一期后路正中切口经双侧肌间隙入路病灶清除植骨内固定术治疗腰椎化脓性感染临床效果观察

Clinical Effect of Lesion Removal and Bone Grafting with Internal Fixation via Single-stage Posterior Midline Incision and Bilateral Intermuscular Space Approach in the Treatment of Lumbar Suppurative Infection

目的观察一期后路正中切口经双侧肌间隙入路病灶清除植骨内固定术治疗腰椎化脓性感染的临床效果。方法对采用一期后路正中切口经双侧肌间隙入路病灶清除植骨内固定术治疗的35例腰椎化脓性感染的临床资料进行回顾性分析。结果本组均顺利完成手术,术中出血量150~550(232.68±18.56)ml;手术时间55~115(87.68±12.69)min。术中所见所有病变椎间盘均被破坏,并伴有不同程度终板及椎体破坏;术后引流量47~385(168.57±44.34)ml。所有患者术后当天感觉疼痛等症状明显缓解。手术前后,35例腰椎化脓性感染日本骨科协会(JOA)腰椎评分标准、视觉模拟评分法(VAS)评分及Cobb角总体比较差异有统计学意义(P<0.01)。术前、术后1个月、术后3个月及末次随访时,随着时间推移,JOA腰椎评分标准评分逐渐升高,VAS评分及腰椎Cobb角逐渐降低,不同时间点间两两比较差异均有统计学意义(P<0.05或P<0.01)。术后12个月随访,所有患者均达到I级愈合标准,随访期间未见节段间塌陷、固定物松动及断裂等现象发生。术后1周,1例出现伤口开裂伴随有脓性分泌物,经再次清创、冲洗2周后愈合;术后1个月,1例因异体骨吸收并假关节形成行2次手术,2次术后6个月随访时发现植骨区骨性愈合;余患者中、远期随访未显示并发症发生。结论一期后路正中切口经双侧肌间隙入路病灶清除植骨内固定术治疗腰椎化脓性感染效果良好且并发症少。

Objective To study the clinical effect of lesion removal and bone grafting with internal fixation via single-stage posterior midline incision and bilateral intermuscular space approach in the treatment of lumbar suppurative infection. Methods The clinical data of 35 patients with lumbar suppurative infection who were treated with lesion removal and bone grafting with internal fixation via single-stage posterior midline incision and bilateral intermuscular space approach were retrospectively analyzed. Results All patients underwent surgery successfully. The intraoperative blood loss was 150-550 ml, with a mean of(232.68±18.56) ml. The duration of operation was 55-115 min, with a mean of(87.68±12.69) min. All the diseased lumbar discs seen intraoperatively were damaged, with varying degrees of endplate and vertebral body damage. The drainage volume after operation was 47-385 ml, with a mean of(168.57±44.34) ml. The pain and other symptoms of all patients were significantly alleviated immediately after the operation. There were significant differences in the overall comparison between the Japanese Orthopaedic Association(JOA) score of lumbar spine, Visual Analogue Scale(VAS) score, and Cobb angle in 35 cases of lumbar vertebral suppurative infection before and after surgery(P<0.01). The JOA score of the lumbar spine was gradually increased, and the VAS score and the Cobb angle of the lumbar spine were gradually decreased with time, including before surgery, in 1 month and 3 months after surgery, and at the last follow-up. The differences between groups were statistically significant at different time points(P<0.05 or P<0.01). Bone graft of patients in 1 year after surgery met class I healing criteria, and no intersegmental collapse, fixation loosening, or breakage occurred during the follow-up. In one week after surgery, 1 patient underwent secondary debridement and rinsing due to a wound dehiscence accompanied by purulent secretion, and the wound was healed in 2 weeks afterwards. In one month after surgery, 1 patient underwent secondary surgery for allogeneic bone resorption and pseudoarticulation formation. Bone healing was found in the bone grafting area in six-month follow-up after secondary surgery. No complications occurred in other patients during the short-term and long-term follow-up. Conclusion Lesion removal and bone grafting with internal fixation via single-stage posterior midline incision and bilateral intermuscular space approach combined with standardized antibiotics can achieve good effects in the treatment of lumbar suppurative infection.