化脓性脊柱炎的手术治疗选择及疗效分析

Surgical treatment options and efficacy analysis of pyogenic spondylodiscitis

目的探讨手术辅以抗感染药物治疗化脓性脊柱炎的临床疗效及预后。方法2013年11月—2021年1月,新疆医科大学第一附属医院手术治疗化脓性脊柱炎患者83例,根据感染部位、邻近椎体破坏程度和神经压迫情况制订手术计划。记录住院时间、手术时间、术中出血量及并发症发生情况,记录术前、术后1个月、术后3个月及末次随访时的白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP)水平等指标。采用疼痛视觉模拟量表(VAS)评分评估疼痛程度,采用美国脊髓损伤协会(ASIA)分级评估神经功能恢复情况。结果所有手术顺利完成,除1例患者死亡,其余患者随访12~46个月,平均25.2个月;住院时间为6~30(18.11±8.01)d,手术时间为45~345(151.67±58.82)min,术中出血量为50~1200m L。所有患者术后均静脉滴注抗生素6~60(20.51±10.92)d,之后口服抗生素6~90(44.71±14.59)d。共51例患者行细菌培养,其中34例检出病原菌,阳性率为66.7%。所有患者术后各时间点WBC、ESR、CRP水平及VAS评分随着随访时间延长逐渐改善,差异均有统计学意义(P<0.05)。术前46例患者存在脊髓神经功能损伤,除1例ASIA分级为A级的患者死亡,其余患者ASIA分级均较术前改善。术中发生脑脊液漏1例,术后发生切口不愈合2例,经对症处理后均明显缓解。结论手术治疗化脓性脊柱炎可彻底清除病灶、重建脊柱序列、矫正后凸畸形,再辅以抗感染药物治疗6~8周可获得满意疗效,复发率低,患者预后良好。

Objective To investigate the clinical efficacy and prognosis of surgeryc ombined with anti-infective drugs in the treatment of pyogenic spondylitis.Methods From November 2013 to January 2021,83 patients with pyogenic spondylitis received surgical treatment in First Affiliated Hospital of Xjiinang Medical University,and the surgical plan was made accordin g to the infection site,the intensity of destruction of adjacent vertebrae and nerve mcporession.The hospital stay,operation time,intraoperative blood loss and complications were recorded.Whiet blood cell coun(t WBC),erythrocyte sedimentation rate(ESR),and C-reactive protein(CRP)level were recorded at pre-operation,postoperative 1 and 3 months,and the final follow-up.The visual analogue scale(VAS)score was used to evaluate the intensity of pain,and the recovery of neurological function was evaluated by American Spinal Injury Associatio(nASIA)classification.Results All the operations were successfully completed.Except 1 patient died,the rest were followed up for 12-46 months,with an average of 25.2 months.The hospital stay was 6-30(18.11±8.01)d,the operation time was 45-345(151.67±58.82)min,and the intraoperative blood loss was 50-1200 mL.After operation,all the patients were treated with intravenous antibiotics for6-6(020.51±10.92)d and then switched to oral antibiotics for 6-9(044.71±14.59)d.Bacterial culture was performed in 51 patients,among which pathogenic bacteria were detected in 34,with a positivity rate of 66.7%.The WBC,ESR,CRP level and VAS score at each time point after operation were improved graduayl lwith the increase of follo-wup time,and the differences were statistically significan(t P<0.05).Spinal cord neurological function injury existed in 46 patitesn before surgery,and the ASIA classification improved in all the patients compared withp re-operation,except for 1 patient with grade A who died.Cerebrospinal fluid leakage occurred in 1 case during the opetriaon and incision nonunion in 2 after the operationw,hich were obviously relieved after symptomatic treatment.Conclusion Surgical treatment of pyogenic spondylitis can completely clera the focus,reconstruct the spinal sequence,correct kyphosis,while supplemented with anti-infection treatment for 6-8 weeks can obtain satisfactory results,with a low recurrence rate and a good prognosis for patients.