经皮椎体强化术后感染相关因素及临床特点分析

Analysis of infection related factors and clinical characteristics after percutaneous vertebral augmentation procedures

目的通过对经皮椎体强化术(PVAP)后感染患者的临床研究,分析感染相关因素及临床特点,为术前预防及诊断提供依据。方法采用回顾性研究方法,对2017年12月至2023年11月上海交通大学医学院附属第九人民医院收治的5例PVAP术后感染患者诊疗经过及预后进行分析。结果男3例,女2例,年龄68~81岁,平均74.8岁,从手术至明确感染的时间为5~24个月,所有患者均表现腰背部疼痛,视觉模拟量表(VAS)评分为7~8分,均有胸腰椎活动受限、局部压痛和叩击痛,4例患者有双下肢不同程度肌力下降等神经症状,其中2例伴二便障碍。实验室检查示白细胞(WBC)计数为(4.0~7.3)×10^(9)/L,C-反应蛋白(CRP)为1.51~66.00 mg/dL,红细胞沉降率(ESR)为2~94 mm/1 h,降钙素原(PCT)为0.10~0.40 ng/mL,X线、CT及MRI检查考虑感染表现,病原学及病理学明确4例结核分枝杆菌,其中1例合并鲍曼不动杆菌,另1例患者诊断为表皮葡萄球菌。末次随访时,2例患者死于并发症,3例患者经手术联合药物治疗后腰背部疼痛缓解,体温正常,炎性指标在正常参考值范围,影像学检查提示未见感染征象。结论术前充分评估和合并症对症处理,术中规范操作,可减少PVAP后感染的发生,一旦发生感染,早期诊断与系统治疗可获得良好效果。

Objective Based on the clinical study of patients infected after percutaneous vertebral augmentation procedures(PVAP),the infection related factors and clinical characteristics were analyzed to provide basis for early prevention and diagnosis.Methods A retrospective study was conducted to analyze the diagnosis and treatment process and prognosis of 5 patients with infection after PVAP in Shanghai Ninth Peaple's Hospital from December 2017 to November 2023.Results There were 3 males and 2 females,aged 68-81 years,with an average age of 74.8 years.The time from operation to infection was 5 to 24 months.All patients presented with low back pain,the visual analogue scale(VAS)score was 7 to 8.All patients had imited thoracolumbar movement,local tenderness and percussion pain.Four patients had nerve symptoms such as decreased muscle strength in both lower limbs to varying degrees,2 of which accompanied by defecation disorder.In laboratory tests,white blood cell(WBC)count was(4.0-7.3)×10^(9)/L,C-reactive protein(CRP)was 1.51-66.00 mg/dL,erythrocyte sedimentation rate(ESR)was 2-94 mm/1 h,and procalcitonin(PCT)was 0.10-0.40 ng/mL.X-ray,CT and MRI indicated the manifestations of infection,etiology and pathology confirmed 4 cases of Mycobacterium tuberculosis,of which 1 case was complicated with Acinetobacter baumannii,and the other case was diagnosed with Staphylococcus epidermidis.At the last follow-up,2 patients died of complications,3 patients were relieved of low back pain after surgery combined with drug treatment,body temperature was normal and inflammatory indicators were within the normal reference value range,and imaging examination showed no signs of infection.Conclusion Adequate preoperative assessment,symptomatic treatment of complications,and standard operation during the operation can reduce the incidence of infection after PVAP.If infection occurs,early diagnosis and systematic treatment can obtain good results.