Schuster J M, Avellino A M, Mann F A, Girouard A A, Grady M S, Newell D W, Winn H R, Chapman J R, Mirza S K
Department of Neurological Surgery, Harborview Injury Prevention and Research Center, Seattle, Washington 98104, USA.
J Neurosurg. 2000 Jul;93(1 Suppl):8-14. doi: 10.3171/spi.2000.93.1.0008.
The use of structural allografts in spinal osteomyelitis remains controversial because of the perceived risk of persistent infection related to a devitalized graft and spinal hardware. The authors have identified 47 patients over the last 3.5 years who underwent a surgical decompression and stabilization procedure in which fresh-frozen allografts were used after aggressive removal of infected and devitalized tissue. The patients subsequently underwent 6 weeks of postoperative antibiotic therapy (12 months for those with tuberculosis [TB]).
Follow-up data included results of serial clinical examinations, radiography, laboratory analysis (erythrocyte sedimentation rate and white blood cell count), and clinical outcome questionnaires. Of the original 47 patients (14 women and 33 men, aged 14-83 years), 39 were available for follow up. The average follow-up period at the time this article was submitted was 17 +/- 9 months (median 14 months, range 6-45 months). In the majority of cases (57%), a Staphylococcus species was the infectious organism. Predisposing risk factors included intravenous drug abuse (IVDA), previous surgery, diabetes, TB, and concurrent infections. During the follow-up period only two patients suffered recurrent infection at a contiguous level; both had a history of IVDA and one also had a chronic excoriating skin condition. No other recurrent infections have been identified, and no patient has required reoperation for persistent infection or allograft/hardware failure.
It is the authors' opinion that the use of structural allografts in combination with aggressive tissue debridement and adjuvant antibiotic therapy provide a safe and effective therapy in cases of spinal osteomyelitis requiring surgery.
由于认为与失活移植物和脊柱内固定器械相关的持续感染风险，结构性同种异体移植物在脊柱骨髓炎中的应用仍存在争议。作者在过去3.5年中确定了47例患者，这些患者接受了手术减压和稳定手术，在积极清除感染和失活组织后使用了新鲜冷冻同种异体移植物。患者随后接受了6周的术后抗生素治疗（结核病患者为12个月）。
随访数据包括系列临床检查、影像学检查、实验室分析（红细胞沉降率和白细胞计数）以及临床结果问卷。在最初的47例患者（14名女性和33名男性，年龄14 - 83岁）中，39例可供随访。在撰写本文时，平均随访期为17±9个月（中位数14个月，范围6 - 45个月）。在大多数病例（57%）中，感染病原体为葡萄球菌属。易感危险因素包括静脉药物滥用、既往手术、糖尿病、结核病和并发感染。在随访期间，仅2例患者在相邻节段出现复发性感染；二者均有静脉药物滥用史，其中1例还患有慢性皮肤糜烂性疾病。未发现其他复发性感染，也没有患者因持续感染或同种异体移植物/内固定器械失败而需要再次手术。
作者认为，在需要手术的脊柱骨髓炎病例中，结构性同种异体移植物与积极的组织清创和辅助抗生素治疗相结合可提供一种安全有效的治疗方法。
