张耀;张强;赵昌松;王晶晶;王鹏;孙磊;赵汝岗;李鑫;孙胜;

• 1:首都医科大学附属北京地坛医院骨科
• 2:首都医科大学附属北京地坛医院病理科

摘要(Abstract)：

[目的]观察一期后路手术治疗腰椎化脓性脊柱炎的临床效果。[方法]回顾性分析2012年11月-2015年3月,本科收治的16例腰椎化脓性脊柱炎患者。其中男11例,女5例;年龄35～74岁,平均(49.23±8.47)岁。临床表现主要为发热、腰背部疼痛、腰椎活动受限,其中存在神经症状11例。实验室检查显示白细胞计数、红细胞沉降率、C反应蛋白升高。MRI主要表现是T1低信号、T2高信号,其中8例见椎管内硬膜外脓肿,7例见局部脓肿,病变节段:L2/3 3人,L3/4 3人,L4/5 9人,L5 S1 1人。所有患者均采用一期后路病灶清除植骨内固定术。[结果]术后切口Ⅰ期愈合15例,Ⅱ期愈合1例。1例术后2周症状复发,经对症处理后恢复,其他患者腰背部疼痛和/或神经症状较术前明显缓解,复查白细胞计数、红细胞沉降率、C反应蛋白较术前明显下降。术后随访12～36个月,平均(25.45±6.27)个月。无窦道形成,无胸腰椎后凸畸形、内固定松动、断裂等情况出现。4～9个月后获得植骨融合。[结论]在抗生素治疗的基础上,一期后路病灶清除植骨内固定是安全、有效的治疗腰椎化脓性脊柱炎的方法。

关键词(KeyWords)： 化脓性脊柱炎;腰椎;一期手术;病灶清除;固定融合术

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张耀;张强;赵昌松;王晶晶;王鹏;孙磊;赵汝岗;李鑫;孙胜;

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DOI:

参考文献(References)：

• [1]Bornemann R,Muller-Broich JD,Deml M,et al.Diagnosis and treatment of spondylodiscitis/spondylitis in clinical practice[J].ZOrthop Unfall,2015,153(5):540-545.
• [2]Lee KY.Comparison of pyogenic spondylitis and tuberculous spondylitis[J].Asian Spine J,2014,8(2):216-223.
• [3]Hadjipavlou AG,Mader JT,Necessary JT,et al.Hematogenous pyogenic spinal infections and their surgical management[J].Spine(Phila Pa 1976),2000,25(13):1668-1679.
• [4]Salem KM,Fisher CG.Anterior column reconstruction with PM-MA:an effective long-term alternative in spinal oncologic surgery[J].Eur Spine J,2015,25(12):1-7.
• [5]Shiban E,Janssen I,da Cunha PR,et al.Safety and efficacy of polyetheretherketone(PEEK)cages in combination with posterior pedicel screw fixation in pyogenic spinal infection[J].Acta Neurochir(Wien),2016,158(10):1851-1857.
• [6]D Agostino C,Scorzolini L,Massetti AP,et al.A seven-year prospective study on spondylodiscitis:epidemiological and microbiological features[J].Infection,2010,38(2):102-107.
• [7]Lee CH,Park CM,Kim KA,et al.Dentification and prediction of transitional vertebrae on imaging studies:anatomical significance of paraspinal structures[J].Clin Anat,2007,20(8):905-914.
• [8]买尔旦·买买提,田娟,盛伟斌,等.布鲁杆菌病性脊柱炎的诊断与手术治疗[J].中华骨科杂志,2012,32(4):323-330.
• [9]Jung NY,Jee WH,Ha KY,et al.Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI[J].AJR Am JRoentgenol,2004,182(6):1405-1410.
• [10]Harada Y,Tokuda O,Matsunaga N.Magnetic resonance imaging characteristics of tuberculous spondylitis vs.pyogenic spondylitis[J].Clin Imaging,2008,32(4):303-309.
• [11]Rutges JP,Kempen DH,van Dijk M,et al.Outcome of conservative and surgical treatment of pyogenic spondylodiscitis:a systematic literature review[J].Eur Spine J,2016,25(4):983-999.
• [12]Boszczyk BM,Krause P,Bolay H,et al.Spinal epidural abscess following blunt pelvic trauma[J].Eur Spine J,2000,9(1):80-84.
• [13]Soehle M,Wallenfang T.Spinal epidural abscesses:clinical manifestations,prognostic factors,and outcomes[J].Neurosurgery,2002,51(1):79-85.
• [14]Seyman D,Berk H,Sep?n-Ozen N,et al.Successful use of tigecycline for treatment of culture-negative pyogenic vertebral osteomyelitis[J].Infect Dis(Lond),2015,47(11):783-788.
• [15]Jeong DK,Lee HW,Kwon YM.Clinical value of procalcitonin in patients with spinal infection[J].J Korean Neurosurg Soc,2015,58(3):271-275.
• [16]甫拉提·买买提,盛伟斌,郭海龙,等.腰椎化脓性脊柱炎的手术治疗[J].中国修复重建外科杂志,2012,26(7):786-789.
• [17]Jevtic V.Vertebral infection[J].Eur Radiol,2004,14(Suppl3):E43-52.
• [18]Liebergall M,Chaimsky G,Lowe J,et al.Pyogenic vertebral osteomyelifs with paralysis.Prognosis and treatment[J].Clin Orthop,1991,269(269):142-150.
• [19]McGuire RA,Eismom FJ.The fate of autogcous bone grafI in surgically treated pyogenic vertebral osteomyelitis[J].J Spinal Disord,1994,7(3):206-215.
• [20]Fushimi K,Miyamoto K,Fukuta S,et al.The surgical treatment of pyogenic spondylitis using posterior instrumentation without anterior debridement[J].J Bone Joint Surg Br,2012,94(6):821-824.
• [21]Boody BS,Jenkins TJ,Maslak J,et al.Vertebral osteomyelitis and spinal epidural abscess:an evidence-based review[J].J Spinal Disord Tech,2015,28(6):E316-327.2018-07-11