原发性腰椎间隙感染病灶清除植骨融合内固定临床疗效分析

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摘要目的探讨原发性腰椎间隙感染后经一期后路病灶清除、植骨融合内固定并术后闭合式伤口灌注冲洗治疗效果。方法回顾性分析于2013年1月至2015年6月在西安市红会医院脊柱外科住院治疗的腰椎间隙感染患者36例，其中女性21例，男性15例，平均年龄61岁(43～68岁)；所有患者均为单一的腰椎间隙感染，其中L_2～3 3例，L_3～411例，L_4～518例，L₅S₁4例；所有患者诊断明确后均行一期后路病灶清除、自体髂骨植骨融合内固定，术后伤口闭合式灌注冲洗2～3周；术中留取标本行病理学检查及细菌培养＋药敏检测，术后常规应用抗生素治疗。结果所有36例患者手术均获得成功，手术时间平均(101±16.3)min，术中失血量180～550 mL，平均(368±75)mL，细菌培养结果提示6例患者为金黄色葡萄球菌，2例患者为铜绿假单胞杆菌，1例为大肠埃希菌，其余27例患者均提示阴性，病理学检查结果提示符合急慢性炎性反应表现。术后3周，所有患者切口均甲级愈合，血常规、血沉、C反应蛋白均明显下降，血清降钙素原恢复至正常水平，术后3个月，患者炎性指标均恢复至正常。术后随访6～18个月，所有患者腰背部疼痛症状均明显缓解，无感染复发病例，椎间隙植骨均获得骨性融合。结论一期后路病灶清除、植骨融合内固定、术后伤口闭合式持续灌注冲洗治疗原发性腰椎间隙感染，具有病灶清除彻底、操作简便易行、避免二次手术创伤的优点，可使患者获得满意的临床疗效。

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关键词 ：原发性腰椎间隙感染, 植骨, 融合, 内固定, 灌注冲洗

Abstract：Objective To evaluate the clinical effects of debridement，bone graft and internal fixation of pedicle screw placement in treating of primary spondylodiscitis through posterior approach.Methods Clinical data of 36 patients with primary spondylodiscitis treated in Honghui Hospital of Xi’an and from January 2013 to June 2015 were retrospectively analyzed.There were 15 males and 21 females with anaverage age of 61 years (range，43～68 years).All patients suffered from single level of spondylodiscitis，including 3 patients at L _2～3 ，11 at L _3～4 ，18 at L _4～5 and 4 at L ₅S₁.All 36 cases underwent one-stage posterior debridement，autogenousilliac bone grafting and internal fixation，tissue samples in focus were collected for bacterial culture and pathological examination during the operation，and then continuously closed irrigation wasapplied for 2～3 weeks postoperatively.Results All patients underwent the surgery successfully.The mean intraoperative estimate blood loss was (368±75) mL ( range，180～550 mL).Results of bacterial culture showed pseudomonas aeruginosa in 1 cases，staphylococcusaureus in 16 case and colibacillosisi in 1 case，with other 27 cases of negative culture results，Pathological results in dicated consistent with the menifestations of acute and chronic inflammation.At 3 weeks after the surgery，procalciton in became normal，an recover of routine bloodtest，erythrocyte sedimentation rate and C-reactive protein presented downtrend.Three months later，all the above lab data came back to norm alvalues.All incisions achieved primary healing.All patients were followed up 6 to 18 months (average，13 months)，and the symptom of pain relieved significantly.No recurrent infection hadhappened.A solid bony fusion was found in all patients after the surgery.Conclusion For patients with primary spondylodiscitis，one-stage posterior debridement，grafting，internal fixation and continuously closed irrigation has the advantages of complete focus clearance，simple and feasible procedures，as well as satisfactory clinical effects，which could avoid reoperationby posterior debridement via bone grafting，fixation and irrigation in one-stage.

Key words： primary spondylodiscitis bone graft fusion internal fixation irrigation

作者简介: 刘海平(1981－ )，男，主治医师，西安交通大学附属西安市红会医院，710000。

引用本文:

刘海平 1，郝定均 1，王晓东 1，赵勤鹏 1，董晓华 2. 原发性腰椎间隙感染病灶清除植骨融合内固定临床疗效分析[J]. 实用骨科杂志, 2017, 23(5): 390-394.
Liu Haiping，Hao Dingjun，Wang Xiaodong，et al. Treatment of Primary Spondylodiscitisby One-stage Posterior Debridement，Bone Graft and Pedicle Screw Placement Fixation. sygkzz, 2017, 23(5): 390-394.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I5/390

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