椎体成形术后手术椎体感染的临床表现和治疗效果

目的报道椎体成形术后手术椎体感染的临床表现和治疗效果。方法回顾性分析2014年1月至2019年6月河南省人民医院脊柱脊髓外科收治的6例椎体成形术后手术椎体感染患者的临床资料。男2例,女4例;年龄64~81岁。背部疼痛视觉模拟评分(VAS)为6~8分;神经功能评分按美国脊髓损伤协会(ASIA)分级:C级2例,E级4例。所有患者均行感染椎体次全切除联合长节段椎弓根螺钉固定,并给予相应的抗菌治疗。根据患者炎症指标、影像学检查和临床表现等综合判断疗效。结果6例患者术后获12~42个月(平均20.4个月)随访,手术时间295~455 min(平均370.8 min),出血量760~2250 mL(平均1536.7 mL)。无出现硬膜撕裂、神经症状加重或死亡等严重并发症。末次随访时所有患者体温正常,手术切口愈合良好。复查炎症指标正常。末次随访时影像学检查显示内固定物无移位,无螺钉松动和钉棒断裂,植骨区域骨性融合良好,原感染椎体无炎症信号。末次随访时患者背部疼痛VAS评分为2~4分。2例患者ASIA分级从C级改善至D级,4例患者维持E级;4例患者最终可独立正常行走,2例患者需助行器辅助行走。结论椎体成形术后手术椎体感染会导致背部疼痛和神经功能障碍。采用椎体次全切除加长节段椎弓根螺钉固定联合相应的抗菌治疗可以取得良好的治疗效果。

Clinical manifestations and management of infectious spondylitis following vertebroplasty or kyphoplasty

Objective To report the clinical manifestations and management of infectious spondylitis following vertebroplasty or kyphoplasty.Methods Six cases of infectious spondylitis following vertebroplasty or kyphoplasty were analyzed retrospectively which had been treated at Department of Spinal Surgery,Henan Provincial People's Hospital between January 2014 and June 2019.They were 2 males and 4 females,aged from 64 to 81 years.Their visual analogue scale(VAS)scores ranged from 6 to 8 points;their spinal cord function was graded as C in 2 cases and E in 4 according to the American Spinal Cord Injury Association(ASIA)grading.All the patients were treated by sub-total resection of the infected vertebra,long segmental pedicle screw fixation and corresponding antibiotics therapy.The therapeutic efficacy was assessed by the inflammation indexes,imaging examinations and clinical manifestations.Results The 6 patients were followed up for 12 to 42 months(mean 20.4 months).Their operation time ranged from 295 to 455 min(mean 370.8 min)and blood loss from 760 to 2,250 mL(mean 1536.7 mL).There were no such serious complications as dural tear,worsening of neurological symptoms or death.The last follow-up revealed normal body temperature and fine incision healing in all patients.Their inflammatory indexes returned to normal.Imaging examinations at the last follow-up showed no displacement of internal implants,no screw loosening or breakage of screws or rods,good bony fusion at the grafting site,and no inflammatory signals from the infected vertebra.At the last follow-up,their VAS for back pain ranged from 2 to 4 points,the ASIA grading was improved from C to D in 2 patients and maintained E in 4.Eventually,4 patients recovered independent normal walking but 2 required a walker.Conclusions Infectious spondylitis following vertebroplasty or kyphoplasty can lead to back pain and neurological dysfunction.Sub-total resection of the infected vertebra,long segmental pedicle screw fixation and corresponding antibiotics therapy can result in fine therapeutic outcomes.