Zhang Tao, Hu Jianzhong, Wu Jianhuang, Liu Jinyang, Ni Shuangfei, Duan Chunyue
Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China; Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
Acta Orthop Traumatol Turc. 2018 Jul;52(4):277-282. doi: 10.1016/j.aott.2018.04.004. Epub 2018 May 18.
The aim of this study was to evaluate the clinical outcomes of one-stage posterior debridement, interbody fusion, and instrumentation, combined with irrigation and drainage, for treating lumbar spondylodiscitis.
The study included 23 patients (13 male and 10 female, mean age: 45 years) who had posterior debridement, interbody fusion, and instrumentation, followed by continuous closed irrigation and drainage for lumbar postoperative spondylodiscitis. The visual analog scale, Oswestry disability index, and lumbar lordosis angle were assessed before and after surgery to evaluate the clinical outcome.
The mean follow-up time was 27 (24-36) months. All patients tolerated the procedure well, and there were no instances of spondylodiscitis recurrence, though a dorsal dermal sinus developed in one patient after surgery. Infection was eliminated, as evidenced by the normalization of the erythrocyte sedimentation rates and C-reactive protein levels. The mean visual analog scale scores were significantly decreased after the operation. The mean lumbar lordosis angle before surgery was 21.61 ± 6.88° and the angle at the final follow-up was 31.61 ± 4.24°. The mean Oswestry disability index scores improved significantly both after the operation and at the follow-up visits (p < 0.05). Bone union was confirmed in all patients at a mean of 8.6 months post-operation, though this was not achieved until 2 years post-operation in one patient. All 3 patients who had neurological deficits showed great improvement at the last follow-up.
Surgical management using one-stage posterior debridement, interbody fusion, and instrumentation, followed by continuous closed irrigation and drainage, might be an effective treatment option for lumbar postoperative spondylodiscitis.
Level IV, Therapeutic study.
本研究旨在评估一期后路清创、椎间融合及内固定联合冲洗引流治疗腰椎椎间盘炎的临床疗效。
本研究纳入23例患者（男13例，女10例，平均年龄45岁），这些患者接受了后路清创、椎间融合及内固定治疗，随后对腰椎术后椎间盘炎进行持续闭式冲洗引流。在手术前后评估视觉模拟量表、Oswestry功能障碍指数和腰椎前凸角，以评估临床疗效。
平均随访时间为27（24 - 36）个月。所有患者对手术耐受性良好，无椎间盘炎复发情况，尽管有1例患者术后出现了背部皮窦。红细胞沉降率和C反应蛋白水平恢复正常，证明感染已消除。术后视觉模拟量表平均评分显著降低。术前腰椎前凸角平均为21.61 ± 6.88°，末次随访时为31.61 ± 4.24°。术后及随访时Oswestry功能障碍指数平均评分均显著改善（p < 0.05）。所有患者平均术后8.6个月确认骨愈合，不过有1例患者直到术后2年才实现骨愈合。所有3例有神经功能缺损的患者在末次随访时均有显著改善。
采用一期后路清创、椎间融合及内固定联合持续闭式冲洗引流的手术治疗方法，可能是治疗腰椎术后椎间盘炎的一种有效选择。
IV级，治疗性研究。
