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采用钽网笼进行一期前路清创与重建治疗复杂性感染性脊柱炎。

Single-stage anterior debridement and reconstruction with tantalum mesh cage for complicated infectious spondylitis.

作者信息

Yang Shih-Chieh, Chen Hung-Shu, Kao Yu-Hsien, Tu Yuan-Kun

机构信息

Department of Orthopedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan.

出版信息

World J Orthop. 2017 Sep 18;8(9):710-718. doi: 10.5312/wjo.v8.i9.710.

DOI:10.5312/wjo.v8.i9.710
PMID:28979855
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5605357/
Abstract

AIM

To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage (TaMC) followed by immediate instrumentation.

METHODS

Single-stage radical debridement and subsequent reconstruction with TaMC instead of autograft or allograft were performed to treat 20 patients with spinal deformity or instability due to complicated infectious spondylitis. Clinical outcomes were assessed by careful physical examination and regular serological tests to determine the infection control. In addition, the visual analog score (VAS), neurologic status, length of vertebral body reconstruction, and the correction of sagittal Cobb angle on radiography were recorded and compared before and after surgery. The conditions of the patients were evaluated based on the modified Brodsky's criteria.

RESULTS

The average VAS score significantly decreased after the surgery (from 7.4 ± 0.8 to 3.3 ± 0.8, < 0.001). The average Cobb angle correction was 14.9 degrees. The neurologic status was significantly improved after the surgery ( = 0.003). One patient experienced refractory infection and underwent additional debridement. Eighteen patients achieved good outcome based on the modified Brodsky's criteria and significant improvement after the surgery ( < 0.001). No implant breakage or TaMC dislodgement was found during at least 24 mo of follow-up.

CONCLUSION

Single-stage anterior debridement and reconstruction with TaMC followed by immediate instrumentation could be an alternative method to manage the patients with spinal deformity or instability due to complicated infectious spondylitis.

摘要

目的

评估采用钽网笼（TaMC）进行一期前路清创重建并即刻内固定治疗复杂性感染性脊柱炎患者的临床及影像学结果。

方法

对20例因复杂性感染性脊柱炎导致脊柱畸形或不稳定的患者进行一期根治性清创，随后采用TaMC而非自体骨移植或同种异体骨移植进行重建。通过仔细的体格检查和定期的血清学检测评估临床结果，以确定感染是否得到控制。此外，记录并比较手术前后的视觉模拟评分（VAS）、神经功能状态、椎体重建长度以及X线片上矢状面Cobb角的矫正情况。根据改良的布罗德斯基标准评估患者的病情。

结果

术后平均VAS评分显著降低（从7.4±0.8降至3.3±0.8，P<0.001）。平均Cobb角矫正为14.9度。术后神经功能状态显著改善（P = 0.003）。1例患者发生难治性感染，接受了再次清创。根据改良的布罗德斯基标准，18例患者术后取得良好效果，病情有显著改善（P<0.001）。在至少24个月的随访期间，未发现植入物断裂或TaMC移位。

结论

采用TaMC进行一期前路清创重建并即刻内固定可能是治疗因复杂性感染性脊柱炎导致脊柱畸形或不稳定患者的一种替代方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/2d202064dfb2/WJO-8-710-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/f763bf17e01d/WJO-8-710-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/b4ef0afac9ed/WJO-8-710-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/8d7dbe411adb/WJO-8-710-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/679141e8ba30/WJO-8-710-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/b6dfc15a2c06/WJO-8-710-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/46d7527df40e/WJO-8-710-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/91b2a1f6a8fa/WJO-8-710-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/2d202064dfb2/WJO-8-710-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/f763bf17e01d/WJO-8-710-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/b4ef0afac9ed/WJO-8-710-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/8d7dbe411adb/WJO-8-710-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/679141e8ba30/WJO-8-710-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/b6dfc15a2c06/WJO-8-710-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/46d7527df40e/WJO-8-710-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/91b2a1f6a8fa/WJO-8-710-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a812/5605357/2d202064dfb2/WJO-8-710-g008.jpg

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