Lerner T, Hackenberg L, Rösler S, Joosten U, Halm H, Liljenqvist U
Klinik und Poliklinik für Allgemeine Orthopädie, Universitätsklinikum Münster.
Z Orthop Ihre Grenzgeb. 2005 Mar-Apr;143(2):204-12. doi: 10.1055/s-2005-836455.
The aim of this study was to evaluate the clinical and radiological results of surgical treatment of thoracic and lumbar vertebral osteomyelitis by means of one-stage extrafocal posterior stabilisation, anterior debridement, and anterior column reconstruction.
A retrospective analysis of the peri- and postoperative parameters of 62 patients with a clinical and radiographic follow-up of 2.6 years that were available for 46 patients was performed. In 42 cases, the anterior column was restored with structural bone grafts, in 20 patients, expandable titanium cages filled with morsellised autologous bone and antibiotic collagen sponges were used. To assess the course of spinal alignment a radiometric analysis was undertaken. Furthermore, the Roland-Morris score (RMS) was applied to evaluate the back pain-related disability.
The diagnosis was made no earlier than 2.7 months after the first symptoms. Preoperatively, 40 % of the patients presented with neurological impairment, of these 76 % improved after surgery. Staphylococcus aureus was the most common pathogen isolated (32 %), Mycobacterium tuberculosis was found in 11 % of the patients. Except for one patient with revision for persistent infection and consecutive failure of the bone graft, primary eradication of the infection was achieved in all cases. At follow-up, bony fusion was radiographically observed in all patients. When using cages, the segmental loss of correction was significantly lower than when using bone grafts (1.0 vs. 4.1 degrees ). At follow-up the RMS averaged 6.6.
One-stage extrafocal posterior stabilisation combined with anterior debridement and anterior column reconstruction with bone grafts or titanium cages is a safe and effective strategy for patients with vertebral osteomyelitis in need of surgery. Titanium cages have proven to be biomechanically advantageous, especially in cases of extensive destruction and are not associated with higher rates of persistence or recurrence of infection compared to autologous bone grafts.
本研究旨在评估通过一期病灶外后路稳定、前路清创和前路柱重建手术治疗胸腰椎椎体骨髓炎的临床和影像学结果。
对62例患者的围手术期和术后参数进行回顾性分析，46例患者有2.6年的临床和影像学随访资料。42例患者采用结构性骨移植修复前路柱，20例患者使用填充有碎自体骨和抗生素胶原海绵的可扩张钛笼。为评估脊柱对线情况，进行了放射测量分析。此外，应用罗兰-莫里斯评分（RMS）评估与背痛相关的残疾情况。
诊断在首次出现症状后2.7个月才做出。术前，40%的患者出现神经功能障碍，其中76%在术后有所改善。金黄色葡萄球菌是最常见的分离病原体（32%），11%的患者发现结核分枝杆菌。除1例因持续感染翻修且骨移植连续失败的患者外，所有病例均实现了感染的初步根除。随访时，所有患者均在影像学上观察到骨融合。使用钛笼时，节段性矫正丢失明显低于使用骨移植时（1.0度对4.1度）。随访时RMS平均为6.6。
一期病灶外后路稳定联合前路清创和用骨移植或钛笼进行前路柱重建，对于需要手术的椎体骨髓炎患者是一种安全有效的策略。已证明钛笼在生物力学上具有优势，特别是在广泛破坏的情况下，与自体骨移植相比，感染持续或复发率并不更高。
