后路病灶清除并植骨内固定治疗原发性腰椎间隙感染

目的评估一期后路病灶清除、植骨并内固定治疗原发性胸腰椎间隙感染的外科疗效。方法回顾性分析2005~2011年收治的18例原发性胸腰椎间隙感染的疗效。所有患者均无椎间盘手术病史及脊柱封闭或穿刺史,纳入诊断均靠术中术后病理确诊。术中病灶清除后植骨内固定,术后继续抗感染治疗。观察手术前后患者腰背部疼痛等症状缓解、神经功能恢复及ESR、CRP变化。结果所有患者术后症状明显缓解,体温正常。ESR及CRP明显下降。18例中仅有3例术后脓液细菌培养结果提示为金黄色葡萄球菌生长,其余均为无菌生长。所有病例术后标本病理结果均提示炎性改变,有中性粒细胞、浆细胞或巨噬细胞浸润,未见结核性改变。随访6~48个月,平均28个月,感染均无复发,影像学检查提示：椎体序列良好,植骨节段均已骨性融合,无内固定物松动、断裂。结论经后路椎间病灶清除,椎间植骨＋椎弓根内固定治疗原发腰椎间隙感染能直接较彻底的清除病灶,矫正畸形,重建脊柱的稳定,椎间融合率高。具有迅速解除症状,缩短疗程,手术安全可靠。

Posterior debridement, grafting and internal fixation for treatment of primary lumbar discitis

Objective Posterior debridement,grafting and internal fixation for treatment of primary lumbar discitis.Methods From 2005 to 2011,18 patientswith primary infection of intervertebraldiscwere analyzed retrospectively.heir clinical course and out-come were studied.None of allhad previous spinal surgery or spinal injection,and theirdiagnosiswere confirmed by pathology.All patientswere treated by debridement,bone autograftand internal fixationa.Anti-bioticswas used by vein after surgery.Results Postoperatively,all patients experienced significant reliefofback pain,improving in the function of movement,and no fever.Only 3 cases had a positive result of Staphylococcus species.heperiod of follow-up lasted 6 months to 48 months with amean of 28 months.There was no recurrence of infection.Postoperative radiological evaluation revealed that implantswere stable,there are no phenomena ofprosthesis subsidence,hook dislodgmentand failure rest oration of spinal segments height.Solid bony fusion was obtained in all patients.Conclusion Posterior debridement,grafting and internal fixation are effective treatments for primary lumbar discitis and can debirde focus of infection completely.Correct deformity and reconstruct stability of spine.it can reduce the time of staying in hospital,this operation is safe and reliable.