前路病灶清除植骨融合后路短钉固定治疗腰椎间隙感染

目的 评估前路病灶清除植骨融合,后路短钉固定治疗腰椎间隙的手术疗效.方法 2008年6月-2013年6月对19例单个腰椎间隙感染的患者采取前路病灶清除植骨融合,后路感染间隙相邻椎体短钉固定术.所有患者均有椎间盘穿刺史.采用视觉模拟评分法评估患者术前、术后腰痛情况,记录术前、术后红细胞沉降率及C-反应蛋白变化情况.治疗前后视觉模拟评分法评分比较使用配对t检验.末次随访时评估植骨融合情况.结果 术后平均随访24个月,所有患者腰痛症状消失,术前腰痛视觉模拟评分法评分(8.42±0.40)分,术后视觉模拟评分法评分(2.27±1.60)分,术前、术后腰痛视觉模拟评分法评分差异有统计学意义(P＜0.05),出院时红细胞沉降率及C-反应蛋白均降至正常范围.末次随访时所有患者植骨已融合,无内固定松动、断裂,且无感染复发.结论 前路病灶清除植骨融合的同时行后路感染间隙相邻椎体短钉固定,不仅能有效的重建脊柱的稳定性,还能最大范围的保留脊柱的运动节段,该方法是治疗腰椎间隙感染的有效术式.

Anterior debridement bone graft fusion and posterior fixation in treatment of intervertebral infection

Objective To explore the clinical outcome with anterior debridement,bone graft and posterior internal fixation with short nail of treating intervertebral infection.Methods Ninteen cases (11 male and 8 female,aged from 34 to 63,46 on average) of lumbar intervertebral space infection treated in our hospital from June 2008 to June 2013 were retrospectively analyzed.These infections occurred at L2-L3 in 2 cases,L3-L4 in 5 cases,L4-L5 in 8 cases and L5-S1 in 4 cases.All patients had history of disc surgery or puncture.The clinical outcome after operation was analyzed according to the low back paine after operation which analyzed by visual analog scale (VAS),and the bone fusion.Erythrocyte sedimentation rata and C-reactionprotein were aslo recorded before and after surgery.Results All cases were followed up,average 24 months.The lower back pain was improved obviously between preoperation and postoperation (P ＜0.05).Also erythrocyte sedimentation rata and C-reactionprotein returned to normal after the operation and all cases had complete bone union at the end of follow-up with no instrument failure noted.Conclusion Anterior debridement,bone graft and posterior internal fixation with short nail in of treating intervertebral infection not only can effectively reconstruct the stability of the spine,but also retain range of motion segment of spine.