Demura S, Murakami H, Shirai T, Kato S, Yoshioka K, Ota T, Ishii T, Igarashi T, Tsuchiya H
Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan,
Eur J Clin Microbiol Infect Dis. 2015 Feb;34(2):261-6. doi: 10.1007/s10096-014-2226-4. Epub 2014 Aug 21.
Reports have detailed the increasing use of spinal instrumentation in the treatment of pyogenic vertebral osteomyelitis, with the aims of achieving a lower pseudoarthrosis rate and restoring spinal alignment. However, controversy remains over the use of instrumentation in the presence of active infection because of concerns about increased bacterial adherence and biofilm formation on the metallic implant surface. Fourteen consecutive patients were followed who were diagnosed as having pyogenic vertebral osteomyelitis and underwent surgery with spinal instrumentation with iodine-containing surfaces that could be directly supported to existing titanium implants. Bone-cage interfaces and implant-related complications after surgery were evaluated. The white blood cell (WBC) count and C-reactive protein (CRP) level were analyzed during the follow-up period. To confirm the influence of iodine release from the implant, thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were also examined. The infection subsided in all 14 patients. Both WBC counts and CRP levels returned to normal ranges by the final follow-up. One patient showed a lucent area around the screw and two patients showed lucencies inside the cage. However, no cage dislocations, cage migrations, or screw pull-outs were noted, and all patients' FT3, FT4, and TSH levels were within normal ranges during the follow-up period. We demonstrated the efficacy of iodine-supported titanium implants in the management of pyogenic vertebral osteomyelitis. No cytotoxicity or adverse effects were noted in this series.
报告详细阐述了脊柱内固定器械在化脓性椎体骨髓炎治疗中的使用日益增加，目的是降低假关节形成率并恢复脊柱排列。然而，由于担心金属植入物表面细菌粘附增加和生物膜形成，在存在活动性感染时使用内固定器械仍存在争议。对连续14例被诊断为化脓性椎体骨髓炎并接受含碘表面脊柱内固定器械手术的患者进行了随访，该器械可直接附着于现有的钛植入物上。评估了手术后骨笼界面和与植入物相关的并发症。在随访期间分析了白细胞（WBC）计数和C反应蛋白（CRP）水平。为了证实植入物释放碘的影响，还检测了促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）。所有14例患者的感染均消退。到最后一次随访时，白细胞计数和CRP水平均恢复到正常范围。1例患者螺钉周围出现透亮区，2例患者骨笼内出现透亮区。然而，未观察到骨笼脱位、骨笼移位或螺钉拔出，并且在随访期间所有患者的FT3、FT4和TSH水平均在正常范围内。我们证明了含碘钛植入物在化脓性椎体骨髓炎治疗中的有效性。本系列未观察到细胞毒性或不良反应。
