一期前路病灶清除植骨融合内固定联合二期后路固定治疗颈椎化脓性脊柱炎

Treatment of cervical suppurative spondylitis with primary anterior debridement and bone graft fusion combined with secondary posterior fixation

目的:探讨一期前路病灶清除植骨融合内固定,二期后路内固定治疗颈椎化脓性脊柱炎的安全性及临床疗效。方法:回顾性分析2016年5月至2020年12月采用一期前路病灶清除植骨融合内固定联合二期后路内固定治疗颈椎化脓性脊柱炎20例患者的病历资料,男14例,女6例;年龄(60.2±12.6)岁(范围40~87岁)。术前均行血培养、白细胞计数(white blood cell count,WBC)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)等实验室检查,根据细菌培养及药敏试验结果指导抗生素选择及使用。术前、术后3个月及12个月随访时评估患者疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopeadic Association,JOA)评分、Frankle神经功能分级,并测量颈椎前凸Cobb角、病变节段角。采用单因素重复测量方差分析进行统计分析。结果:20例患者均顺利完成手术。病原学检查提示金黄色葡萄球菌9例,链球菌4例,大肠埃希菌2例,余5例细菌培养阴性。20例患者均获得随访,随访时间为(18.3±6.7)个月。WBC、ESR、CRP术后3个月及12个月随访时均较术前明显下降(F值分别为17.90、30.65、18.64,均P<0.001);术后3个月VAS评分为(1.35±0.49)分、12个月为(1.15±0.48)分较术前(4.95±1.10)分均明显降低(F=176.12,P<0.001);术后3个月JOA评分为(15.40±1.93)分、12个月为(16.06±1.36)分较术前(11.45±2.78)分均明显好转(F=65.33,P<0.001)。术后即刻C 2~C 7颈椎前凸Cobb角为14.45°±4.36°、12个月为13.70°±3.15°较术前8.25°±4.36°明显增大(F=72.54,P<0.001)。术后即刻病变节段角为3.60°±1.90°,术后12个月为2.90°±1.44°较术前-3.6°±5.2°(负值表示后凸畸形)明显增大(F=42.49,P<0.001)。术后12个月随访时所有植骨区域均获得骨性融合。结论:一期前路病灶清除植骨融合内固定联合二期后路固定治疗颈椎化脓性脊柱炎可有效进行椎管内减压,改善患者疼痛及神经功能,并可恢复颈椎稳定、矫正后凸畸形,临床疗效满意。

Objective To investigate the safety and clinical efficacy of primary anterior lesion removal and bone graft fusion combined with secondary posterior fixation in the treatment of cervical suppurative spondylitis.Methods Retrospective analysis was performed on the data of twenty cervical suppurative spondylitis patients treated with primary anterior lesion removal and bone graft fusion combinedwith secondary posterior fixation in our hospital from May 2016 to December 2020,including 14 males and 6 females.Aging from 40 to 87 years,with an average of 60.2±12.6 years.The laboratory tests of preoperative blood culture,such as white blood cell count(WBC),erythrocyte sedimentation rate(ESR),and hypersensitive C-reactive protein(CRP)were performed.The selection and duration of antibiotic usewere guided according to bacterial culture and laboratory test results.visual analogue scale(VAS)score,Japanese Orthopeadic Association(JOA)score and Frankle classification of neurological function were evaluated before surgery,3 months after surgery,and 12 months after surgery,so were the Cobb angle and segmental angle of cervical lordosis.Single factor repeated measure ANOVA was used for statistical analysis of data.Results Surgeries were performed successfully for all the 20 patients.9 cases of Staphylococcus aureus,4 cases of Streptococcus and 2 case of Escherichia coli were detected by pathogen examination.The remaining 5 cases were negative in bacterial culture.All 20 patients were followed up for 18.3±6.7 months.WBC,ESR and CRP at 3 and 12 months after surgery were significantly lower than those before surgery(F value:17.90,30.65,18.64,P<0.001).The VAS at 3 months after surgery 1.35±0.49 and 12 months after surgery 1.15±0.48 were significantly lower than that before surgery 4.95±1.10(F=176.12,P<0.001).The JOA score at 3 months after surgery 15.40±1.93 and 12 months after surgery 16.06±1.36 were significantly better than that before surgery 11.45±2.78(F=65.33,P<0.001).The Cobb Angle of C2-C7 cervical lordosis after surgery 14.45°±4.36°and 12 months after surgery(13.70°±3.15°)were significantly larger than that before surgery(8.25°±4.36°)(F=72.54,P<0.001).Cobb angle of the lesion segment after surgery(3.60°±1.90°)and 12 months after surgery(2.90°±1.44°)were significantly better than that before surgery(-3.55°±5.74°)(negative value indicated kyphosis)(F=42.49,P<0.001).Bone fusion was observed in all graft areas at 12 months of follow-up.Conclusion The treatment of cervical suppurative spondylitis with primary anterior lesion removal and bone graft fusion combined with secondary posterior fixation can effectively obtain intraspinal decompression,improve pain and nerve function,as well as restore cervical stability and correct kyphosis,with satisfactory clinical efficacy.