前路椎间植骨融合内固定术治疗晚期腰椎间盘炎。
Anterior interbody grafting and instrumentation for advanced spondylodiscitis.
作者信息
Lim Jae Kwan, Kim Sung Min, Jo Dae Jean, Lee Tae One
机构信息
Department of Neurosurgery , College of Medicine, Hallym University, Seoul, Korea.
出版信息
J Korean Neurosurg Soc. 2008 Jan;43(1):5-10. doi: 10.3340/jkns.2008.43.1.5. Epub 2008 Jan 20.
OBJECTIVE
To evaluate the surgical outcomes of ventral interbody grafting and anterior or posterior spinal instrumentation for the treatment of advanced spondylodiscitis in patients who had failed medical management.
METHODS
A total of 28 patients were evaluated for associated medical illness, detected pathogen, level of involved spine, and perioperative complications. Radiological evaluation including the rate of bony union, segmental Cobb angle, graft- and instrumentation-related complications, and clinical outcomes by mean Frankel scale and VAS score were performed.
RESULTS
There are 14 pyogenic spondylodiscitis, 6 postoperative spondylodiscitis, and 8 tuberculous spondylodiscitis. There were 21 males and 7 females. Mean age was 51 years, with a range from 18 to 77. Mean follow-up period was 10.9 months. Associated medical illnesses were 6 diabetes, 3 pulmonary tuberculosis, and 4 chronic liver diseases. Staphylococcus was the most common pathogen isolated (25%), and Mycobacterium tuberculosis was found in 18% of the patients. Operative approaches, either anterior or posterior spinal instrumentation, were done simultaneously or delayed after anterior aggressive debridement, neural decompression, and structural interbody bone grafting. All patients with neurological deficits improved after operation, except only one who died from aggravation as military tuberculosis. Mean Frankel scale was changed from 3.78+/-0.78 preoperatively to 4.78+/-0.35 at final follow up and mean VAS score was improved from 7.43+/-0.54 to 2.07+/-1.12. Solid bone fusion was obtained in all patients except only one patient who died. There was no need for prolongation of duration of antibiotics and no evidence of secondary infection owing to spinal instrumentations.
CONCLUSION
According to these results, debridement and anterior column reconstruction with ventral interbody grafting and instrumentation is effective and safe in patients who had failed medical management and neurological deficits in advanced spondylodiscitis.
目的
评估在药物治疗无效的患者中，前路椎间植骨融合联合前路或后路脊柱内固定治疗晚期脊椎椎间盘炎的手术效果。
方法
对28例患者进行相关内科疾病、检出病原体、受累脊柱节段及围手术期并发症的评估。进行影像学评估，包括骨融合率、节段性Cobb角、植骨及内固定相关并发症，以及采用平均Frankel分级和视觉模拟评分法（VAS）评估临床疗效。
结果
有14例化脓性脊椎椎间盘炎、6例术后脊椎椎间盘炎和8例结核性脊椎椎间盘炎。男性21例，女性7例。平均年龄51岁，范围为18至77岁。平均随访期为10.9个月。相关内科疾病包括6例糖尿病、3例肺结核和4例慢性肝病。最常见的分离病原体为金黄色葡萄球菌（25%），18%的患者检出结核分枝杆菌。手术方式为前路或后路脊柱内固定，在积极的前路清创、神经减压和结构性椎间植骨后同时或延迟进行。所有神经功能缺损患者术后均有改善，仅1例因粟粒性结核病情加重死亡。平均Frankel分级术前为3.78±0.78，末次随访时为4.78±0.35，平均VAS评分从7.43±0.54改善至2.07±1.12。除1例死亡患者外，所有患者均获得了坚实的骨融合。无需延长抗生素使用时间，也没有因脊柱内固定导致继发感染的证据。
结论
根据这些结果，对于药物治疗无效且晚期脊椎椎间盘炎伴有神经功能缺损的患者，清创并采用前路椎间植骨融合联合内固定进行前柱重建是有效且安全的。
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