前路病灶清除、异体骨植骨融合、钛板内固定治疗下颈椎感染

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摘要目的探讨前路病灶清除、异体骨植骨融合、钛板内固定治疗下颈椎感染的临床疗效。方法 2011年4月至2015年6月我院采用前路病灶清除、异体骨植骨融合、钛板内固定治疗下颈椎感染患者57例，其中结核性感染(A组)36例，布氏杆菌性感染(B组)13例，化脓性感染(C组)8例。男32例，女25例，平均(53.1±7.95)岁。术后严格随访至少12个月，现对已收集的临床资料进行回顾性分析。根据临床表现、实验室和影像学检查结果探讨3种颈椎感染的临床特点。采用颈痛VAS评分、颈椎JOA评分、脊髓损伤Frankle分级以及颈椎Cobb角评价手术疗效，并根据Bridwell融合标准评价异体骨植骨融合效果。结果所有患者均顺利完成手术，无脊髓、神经、血管损伤相关并发症。平均手术时间(102.5±28.8)min，平均出血量(112.2±48.7)mL。所有患者均获得随访，平均随访时间(22.7±8.1)个月。末次随访时，颈痛VAS评分从术前(6.43±1.64)分改善至(0.81±0.74)分，改善率87.4％；根据颈椎JOA评分进行疗效评价，优42例(73.7％)，良11例(19.3％)，中3例(5.2％)，差1例(1.8％)，优良率为93％；Bridwell融合标准：52例达到Ⅰ级融合，总的有效融合率达到91％；脊髓损伤Frankle分级：术前34例(59.6％)合并神经功能障碍，其中A组23例(63.9％)，B组6例(46.2％)，C组5例(62.5％)，末次随访时除了3例Frankle分级D级外，其余均恢复正常。结核性感染组中，2例因假关节形成、1例因后凸畸形伴神经功能障碍进行二次手术。随访中，所有患者未发生切口感染，内固定或植骨块脱出及感染复发。结论对于结核性、布氏杆菌性及化脓性下颈椎感染性疾病，采用前路手术可达到彻底病灶清除，椎管减压的目的。术中植入异体骨和钛板等内置物安全、可靠，且能提高手术疗效。

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关键词 ：下颈椎感染, 前路手术, 异体骨植骨融合, 钛板内固定

Abstract：

Objective To discuss the clinical efficacy of anterior debridement，allografting and titanium plate instrumentation for lower cervical spondylodiscitis.Methods 57 patients with lower cervical spondylodiscitis treated by anterior debridement，allografting and titanium plate instrumentation in our hospital from April 2011 to June 2015，including 36 cases of tuberculosis (A group)，13 cases of brucellosis (group B)，8 cases of pyogenic infections (group C).There were 32 males and 25 females，with a mean age of (53.1±7.95) years.All of the patients were followed-up at least 12 months.Now we retrospectively analyzed the collected clinical data.Clinical features of 3 kinds of cervical spondylodiscitis were discussed according to clinical manifestations，laboratory and imaging findings.Efficacy of surgery was evaluated using pre-operative and last follow-up neck pain VAS score，JOA score，Frankel grade and Cobb angle，and allogeneic bone fusion was evaluated according to Bridwell standard as well.Results All patients were successfully operated without the surgical related complications like spinal cord，nerve，blood vessel damage.The mean operative time was (102.5±28.8)min，mean blood loss was (112.2±48.7) mL，the average follow-up period was (22.7±8.1) months.At last follow-up，neck pain VAS score improved from preoperative (6.43±1.64) to (0.81±0.74)，with a improvement rate of 87.4％.Cervical JOA score improvement was excellent in 42 cases (73.7％)，good in 11 cases (19.3％)，3 cases (5.2％)，and poor in 1 (1.8％)，showing a fine rate of 93％.52 cases of fusion reached level Ⅰ according to the Bridwell fusion standard，the total effective fusion rate was 91％；Frankle grade showed that 34 cases (59.6％) combined with neurological dysfunction preoperative，including 23 cases (63.9％) in group A，6 cases (46.2％) in group B，5 cases (62.5％) in group C，at the last follow-up except 3 cases` Frankle grade improved to grade D，the other patients were back to normal.3 cases of tuberculosis group were re-operated，2 cases were due to pseudarthrosis，1 patient was due to kyphosis related neurological disorders.During the follow-up period，no one patient occurred wound infection，internal fixation or allogenic bone graft prolapse and recurrence.Conclusion For tuberculous，brucellar and pyogenic lower cervical spondylodiscitis，anterior surgery can obtain complete debridement and spinal cord decompression.The application of allogeneic bone graft and titanium plate is safe and reliable，and can improve the clinical efficacy.

Key words： lower cervical spondylodiscitis anterior approach allogeneic bone grafting titanium plate instrumentation

作者简介: 王振斌(1980－ )，男，主治医师，新疆医科大学附属第四医院脊柱一科，830000。

引用本文:

王振斌，涂来勇，卡哈尔·艾肯木，楚戈，赵疆. 前路病灶清除、异体骨植骨融合、钛板内固定治疗下颈椎感染[J]. 实用骨科杂志, 2017, 23(6): 481-486.
Wang Zhenbin，Tu Laiyong，Cajal·Aikenmu，et al. Anterior Debridement，Allogeneic Bone Grafting and Titanium Plate Instrumentation for Lower Cervical Spondylodiscitis. sygkzz, 2017, 23(6): 481-486.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I6/481

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