自发性脊柱感染的手术治疗临床分析
A clinical analysis of surgical treatment for spontaneous spinal infection.
作者信息
Lee Dong-Geun, Park Kyung Bum, Kang Dong-Ho, Hwang Soo Hyun, Jung Jin Myung, Han Jong Woo
机构信息
Department of Neurosurgery, Gyeongsang National University, College of Medicine, Jinju, Korea.
出版信息
J Korean Neurosurg Soc. 2007 Oct;42(4):317-25. doi: 10.3340/jkns.2007.42.4.317. Epub 2007 Oct 20.
OBJECTIVE
The purpose of the study was to determine the clinical effects of anterior radical debridement on a series of patients with spontaneous spinal infection.
METHODS
We retrospectively analyzed the clinical characteristics of 32 patients who underwent surgical treatment from January 2000 to December 2005 in our department. The average follow-up Period was 33.4 months (range, 6 to 87 months). Thirty-two patients presented with the following : 23 cases with pyogenic spondylitis, eight with tuberculous spondylitis and one with fungal spondylitis. The indications for surgery were intractable pain, failure of medical management, neurological impairment with or without an associated abscess, vertebral destruction causing spinal instability and/or segmental kyphosis.
RESULTS
The study included 15 (46.9%) males and 17 (53.1%) females ranging in age from 26 to 75 years (mean, 53.1 years). Diabetes mellitus (DM) and pulmonary Tbc were the most common predisposing factors for pyogenic spondylitis and tuberculous spondylitis. Staphylococcus aureus (13%) was the main organism isolated. The most prevalent location was the lumbar spine (75%). Changes in the pain score, Frankel's classification, and laboratory parameters demonstrated a significant clinical improvement in all patients. However, there were recurrent infections in two patients with tuberculous spondylitis and inappropriate debridement and intolerance of medication and noncompliance. Autologous rib, iliac bone and allograft (fibular) were performed in most patients. However, 10 patients were grafted using a titanium mesh cage after anterior radical debridement. There were no recurrent infections in the 10 cases using the mesh cage with radical debridement.
CONCLUSION
The findings of this study indicate that surgery based on appropriate surgical indications is effective for the control of spinal infection and prevention of recurrence with anterior radical debridement, proper drug use and abscess drainage.
目的
本研究旨在确定前路根治性清创术对一系列自发性脊柱感染患者的临床疗效。
方法
我们回顾性分析了2000年1月至2005年12月在我科接受手术治疗的32例患者的临床特征。平均随访时间为33.4个月（范围6至87个月）。32例患者情况如下：23例化脓性脊柱炎，8例结核性脊柱炎，1例真菌性脊柱炎。手术指征为顽固性疼痛、内科治疗无效、伴有或不伴有相关脓肿的神经功能损害、椎体破坏导致脊柱不稳定和/或节段性后凸。
结果
本研究包括15例（46.9%）男性和17例（53.1%）女性，年龄在26至75岁之间（平均53.1岁）。糖尿病（DM）和肺结核是化脓性脊柱炎和结核性脊柱炎最常见的诱发因素。分离出的主要病原体是金黄色葡萄球菌（13%）。最常见的部位是腰椎（75%）。疼痛评分、Frankel分级和实验室参数的变化表明所有患者临床均有显著改善。然而，2例结核性脊柱炎患者出现复发感染，清创不当、药物不耐受和不依从。大多数患者采用自体肋骨、髂骨和同种异体移植物（腓骨）。然而，10例患者在进行前路根治性清创术后使用钛网笼植骨。10例使用网笼并进行根治性清创的患者未出现复发感染。
结论
本研究结果表明，基于适当手术指征的手术对于控制脊柱感染以及通过前路根治性清创、合理用药和脓肿引流预防复发是有效的。
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