Linhardt O, Krüger A, Krödel A
Orthopädische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich.
Z Orthop Ihre Grenzgeb. 2004 Jan-Feb;142(1):73-8. doi: 10.1055/s-2004-818031.
The present study on spondylodiscitis patients was carried out to compare prospectively and randomized the results of clinical and radiological outcomes of anterior versus posterior instrumentation after debridement and grafting. We aimed to make a recommendation concerning the optimum treatment of spondylodiscitis.
A total of 22 patients with spondylodiscitis were enrolled in the randomized trial to undergo an operation with anterior or posterior instrumentation after debridement and fusion with autologous bone transplant. 12 patients (group 1) were assigned to posterior Universal Spine System stabilization. 10 patients (group 2) were treated with anterior VentroFix instrumentation. In a prospective clinical investigation we have examined both operative therapies with regard to clinical and radiological outcome. The follow-up was one year.
In patients with ventral Spondylodesis (group 2), prior recreation of patients was achieved in clinical examination and blood tests. Radiological results are even equivalent in both groups. Therefore we recommend ventral instrumentation as the superior surgical procedure. But the individual local situation has to enable ventral stabilization.
We found advantages with anterior instrumentation in comparison to posterior stabilization in patients with spondylodiscitis. Advantages of ventral stabilization cause early mobilization postoperatively without any increase in complication rates. Except for operation time and intraoperative blood loss, no statistical difference were was seen. Important is the individual indication for each method depending on anatomical and clinical signs. Ventral instrumentation should be restricted to cases with sufficient bone stock.
本研究针对脊椎椎间盘炎患者进行，旨在对清创及植骨后前路与后路内固定的临床和放射学结果进行前瞻性随机比较。我们旨在就脊椎椎间盘炎的最佳治疗方法提出建议。
共有22例脊椎椎间盘炎患者纳入随机试验，在清创并自体骨移植融合后接受前路或后路内固定手术。12例患者（第1组）接受后路通用脊柱系统固定。10例患者（第2组）采用前路VentroFix内固定治疗。在一项前瞻性临床研究中，我们对两种手术治疗的临床和放射学结果进行了检查。随访时间为一年。
在前路椎体融合术患者（第2组）中，临床检查和血液检查显示患者先前的恢复情况良好。两组的放射学结果相当。因此，我们推荐前路内固定作为更优的手术方法。但个体局部情况必须能够进行前路稳定固定。
我们发现，对于脊椎椎间盘炎患者，前路内固定相较于后路稳定固定具有优势。前路稳定固定的优势在于术后可早期活动，且并发症发生率无任何增加。除手术时间和术中失血量外未见统计学差异。重要的是根据解剖和临床体征对每种方法进行个体化指征选择。前路内固定应限于有足够骨量的病例。
