经前路、侧前方入路病灶清除一期植骨单钉棒内固定治疗腰椎单间隙感染的远期疗效

目的 探讨经前路、侧前方入路病灶清除一期植骨单钉棒内固定治疗腰椎单间隙感染的远期疗效。方法 回顾性分析2000年1月—2009年12月蚌埠医学院第一附属医院37例采用经前路、侧前方入路病灶清除一期植骨内固定治疗腰椎单间隙感染患者的临床资料。其中男18例,女19例;年龄19～59岁,平均(49.9±11.0)岁。观察对比患者术前与术后3天、2周、3个月、末次随访时体温、血常规(WBC和中性粒细胞百分比)和VAS评分情况,对比术前与术后7天、2周、3个月、末次随访时红细胞沉降率(ESR)、C反应蛋白(CRP)变化情况。术后定期复查腰椎病变节段正侧位X线片,观察椎间植骨融合情况。术后3个月、末次随访时根据患者VAS评分及X线片复查情况行疗效评价。结果 37例患者均顺利完成手术,结合患者病史、临床表现、影像学表现及术后细菌培养结果,均符合椎间隙感染诊断。所有患者切口达到一期愈合。术后37例患者均获随访,随访时间66～177个月,平均(120.7±30.8)个月。患者术后3天、2周、3个月、末次随访时VAS评分、体温均低于术前,差异均有统计学意义(P值均<0.05);患者术后3天WBC高于术前,术后2周、3个月、末次随访时WBC、中性粒细胞百分比均低于术前,差异均有统计学意义(P值均<0.05);患者术后7天、2周、3个月、末次随访时ESR、CRP均低于术前,差异均有统计学意义(P值均<0.05)。术后3个月评定疗效:优25例,良11例,可1例,优良率97.3%(36/37);末次随访时临床疗效均达优。结论 经前路、侧前方入路病灶清除一期植骨单钉棒内固定术是一种疗效明显、经济实用的手术方式,对于经保守治疗效果不佳、症状严重的患者值得推广应用。

The long term efficacy of focal cleaning treatment by anterior or anterolateral and the first phase of bone graft and single screw rod fixation surgical intervention treatment of single intervertebral space infection.

Objective To investigate the long term efficacy of focal cleaning treatment by anterior or anterolateral and the first phase of bone graft and single screw rod fixation surgical intervention treatment of single intervertebral space infection.Methods Clinical data of 37 patients (18 males, 19 females) with anterior and anterolateral debridement graft bone fusion and internal fixation in treating single intervertebral space infection in patients in the First Affiliated Hospital of Bengbu Medical College from January 2000 to December 2009 were retrospectively analyzed. Age 19-59 years old, average (49.9±11.0) years old, the body temperature, blood routine and visual analogue scale(VAS) were measured at preoperative and 3 days, 2 weeks, 3 months after operation and the time of the last follow-up. Erythrocyte sedimentation rate(ESR), C reactive protein(CRP) were measured at preoperative and 7 days, 2 weeks, 3 months after operation and the time of the last follow-up. X-ray of abnormal segment of lumbar spine were reviewed to observe the fusion situation of intervertebral bone graft. The curative effect evaluation were made according to the VAS score and X ray 3 months after operation, the time of the last follow-up.Results Surgery was successfully performed in all patients. According to patient history, clinical presentation, imaging findings and the Results of bacterial culture, all the patients were in accordance with the infection of intervertebral space. All incisions healed by first intention. All 37 patients were followed up for 66-177 months, with an average of (120.7±30.8) months. For all the patients 3 days, 2 weeks, 3 months after surgery, the end of the follow-up VAS score, and body temperature were lower than those of the preoperative, these differences had statistical significance (all P values<0.05). The white blood cell count of the 3 day after operation was higher than that of the preoperative , all patients of 2 weeks ,3 months after surgery, the end of the follow-up the white blood cell count and the percentage of neutrophil were lower than those of the preoperative, these differences had statistical significance (all P values <0.05). All patients of 1 week, 2 weeks, 3 months after surgery, the end of the follow-up ESR, CRP were lower than those of the preoperative, these differences had statistical significance (all P values<0.05). At 3 months after operation, excellence 25, good 11, tolerableness 1, the excellent and good rate was 97.3%(36/37).Conclusions Focal cleaning treatment by anterior or anterolateral and the first phase of bone graft and single screw rod fixation surgical intervention treatment is a kind of obvious curative effect, economic and practical operation, it should be advocated for the patients who are inefficacious and have severe symptoms.