经前入路、侧前方入路病灶清除术治疗脊柱椎间隙感染

Anterior or Anterolateral Surgical Intervention Interventebral Infection

目的 :分析椎间隙感染的病因及病理机制 ,评价经前入路、侧前方入路病灶清除术治疗椎间隙感染的疗效。方法 :自 1991年 4月～ 2 0 0 2年 5月对 31例椎间隙感染患者 ,分别采用经前入路 (2 5例 )、侧前方入路 (6例 )病灶清除术进行治疗 ,其中 15例Ⅰ期植骨。结果 :随访 3月～ 5a,平均 12 .6个月。所有病例痉挛性剧烈腰痛术后即刻消失 ,细菌培养 18例阳性。CPR平均 2周转阴 ,ESR平均 3周降至正常。 2～ 3周下床活动。结论 :椎间隙感染的主要病因为细菌感染。经前入路、侧前方入路病灶清除减压治疗椎间隙感染具有术野暴露广泛 ,病灶清除彻底 ,减压充分 ,疗效可靠 ,疗程缩短 ,能迅速解除患者痛苦等优点 ,Ⅰ期椎间植骨有利于保持椎体高度及脊柱稳定性。

Objective:To analyse etiology and pathogenic mechanism of intervertebral infection and evaluate the efficacy of focal cleaning treatment by anterior or anterolateral surgical intervention.Methods:31 patients that had intervertebral infection under went anterior(25 cases) or anterolateral(6 cases) surgical intervention,including 15 cases of opinal fusion with stage I bone antograft.Results:Spasmodis pain disappeared immediately after the operation.CRP and ESR decreased to the normal value within 9 days,15 days and 21 days.Patients could more araund 2～3 weeks after the operation.There were 18 positive cases in the bacterial culture.Conclusion:The most possible etiological factor of intervertebral infection is associated with bacterical infection.Anterior or lateral-anterior approach in the treatment of intervertebral-disc infection has the characteristics of extensive exposure,complete lesion removal and decompression.It has the advantages of shortening the course of treatment and the rapid relief of the pain.Spinal fusion with stage I bone antograft can secure spinal stability and maintain spinal height.