一期前后联合入路治疗腰椎非特异性感染的临床疗效

    Effect of one-stage combined with anterior and posterior approach in the treatment of lumbar nonspecific infection

    • 摘要: 目的:观察一期前后联合入路治疗腰椎非特异性感染的临床疗效。方法:对纳入手术标准的12例腰椎非特异性感染采取一期后路椎弓根螺钉固定、前路病灶清除椎间自体骨移植。术后持续使用抗生素治疗6~12周,直至红细胞沉降率(ESR)及C反应蛋白(CRP)水平正常2~4周后停用抗生素。对病人门诊治疗、术前及术后1个月、2个月和3个月的ESR及CRP进行对比。结果:术后病人症状明显改善,12例病人切口均甲级愈合,无窦道、瘘管形成及感染复发。随访18~30个月,术后5~7个月植骨均骨性融合,无椎体明显塌陷及假关节形成。病人术前、术后1个月、2个月和3个月的CRP水平较门诊治疗时均降低(P<0.05~P<0.01),而病人术后1、2和3个月的ESR水平均较门诊治疗时及术前降低(P<0.01)。结论:一期后路椎弓根螺钉固定、前路病灶清除椎间自体骨移植治疗腰椎非特异性感染效果明显,内固定避开感染病灶,减少潜在感染复发风险,促进病情恢复,是一种有效的治疗方法。

       

      Abstract: Objective: To investigate the clinical effects of one-stage combined with anterior and posterior approach in the treatment of lumbar nonspecific infection.Methods: Twelve patients with lumbar nonspecific infection were treated with one stage posterior pedicle screw fixation,scavenging the infection and intervertebral autogenous bone graft.The patients were treated with antibiotics for 6 to 12 weeks,and the antibiotics did not be used until the levels of erythrocyte sedimentation rate(ESR) and C reactive protein(CRP) recovered normal after 2 to 4 weeks of treatment.The levels of ESR and CRP before operation and after 1,2 and 3 months of operation were compared.Results: After operation,the symptoms of the patients were improved significantly,the incision of 12 cases were first rate healing,and there were no formation of sinus tract and fistula,and recurrence of infection.The following-up time was 18 to 30 months,all bone grafts were solid bony fusion,and no obvious vertebral body collapse and pseudarthrosis were found after 5 to 7 months of operation.The levels of CRP of patients before operation and after 1,2 and 3 months of operation were lower than that in the outpatient treatment(P<0.05 to P<0.01),and the levels of ESR of patients after 1,2 and 3 months of operation were lower than that in the outpatient treatment and before opertaion(P<0.01).Conclusions: The clinical effect of one stage posterior pedicle screw fixation,scavenging the infection and intervertebral autogenous bone graft is obvious,which can avoid the infected lesions,reduce the potential risk of infection recurrence and promote the recovery of illness,and is an effective method.

       

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