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Evaluation of Percutaneous Pedicle Screw Fixation in Patients with Pyogenic Spondylitis of the Thoracolumbar Spine 被引量:1
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作者 Katsunori Fukutake Akihito Wada +4 位作者 Daisuke Kamakura Kazumasa Nakamura Shintaro Tsuge Keiji Hasegawa Hiroshi Takahashi 《Open Journal of Orthopedics》 2020年第11期303-312,共10页
<b style="line-height:1.5;"><span style="font-family:Verdana;">Background</span><span style="font-family:Verdana;">:</span><span style="font-size:10.... <b style="line-height:1.5;"><span style="font-family:Verdana;">Background</span><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">Basic principle for the treatment of pyogenic spondylitis (PS) is conservative care, but surgical intervention is often required when conservative treatment may fail. We have experienced many conservative cases of various complications due to long-term bed rest and poor pain control. Recently we have adopted percutaneous pedicle screw (PPS) fixation for the treatment of PS as a minimally invasive spine stabilization (MISt) fusion to reduce such morbidity of the conservative care. </span><b><span style="font-family:Verdana;font-size:12px;">Objective</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">To evaluate the impact of PPS fixation in patients with PS. </span><b><span style="font-family:Verdana;font-size:12px;">Study Design</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">A retrospective analysis of the medical records. </span><b><span style="font-family:Verdana;font-size:12px;">Subjects, Methods</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">We reviewed 54 consecutive patients who underwent treatment in our hospital for PS during 2005-2018 and observed for more than 12 months. Of those we excluded cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> effectiveness to initial treatment (it was defined fever relief or C-reactive protein (CRP) inversion in 3 weeks of antibiotics) so that this study is a retrospective study in cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> initial treatment resistance. Finally, this study included 29 cases. Medical records of these 29 cases were reviewed for baseline, organism isolated and its detection rate, the clinical outcome in 12 months (Discharge, Transfer, Death), the period from </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">first visit to our hospital to fever relief, CRP inversion, ambulation, and Discharge or Transfer. </span><b><span style="font-family:Verdana;font-size:12px;">Results</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span></b><span style="line-height:1.5;font-family:Verdana;"> These cases </span><span style="line-height:1.5;font-family:Verdana;">were </span><span style="line-height:1.5;font-family:Verdana;">divided into two groups, the conservative group (C-group): 17 cases, and the PPS group (P-group): 12 cases. There is no statistically significant difference in fever relief (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.051) and CRP inversion (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.208). The period to ambulation and discharge or transfer was significantly shorter in group P (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.020, p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.031). 1-Year survival rate was 92% in the P-group, and 71% in the C-group. There is no statistically significant difference (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.354) between </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">two groups. The rate of Discharge to home and care facility is 58% in P-group, and 47% in C-group. And the rate of Transfer is 34% in P-group, and 35% in C-group. </span><b><span style="font-family:Verdana;font-size:12px;">Conclusion</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">PPS fixation was effective to achieve shorten</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> the period to ambulation and discharge or transfer. But it was not effective </span><span style="line-height:1.5;font-family:Verdana;">in</span><span style="line-height:1.5;font-family:Verdana;"> infection control. This suggests that PPS fixation should be aggressively administered to patients who can expect pain relief and early ambulation by PPS fixation in the patient of PS show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> resistance to initial treatment. 展开更多
关键词 Pyogenic Spondylitis percutaneous pedicle Screw fixation
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