Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
Bone Joint J. 2019 Jan;101-B(1):75-82. doi: 10.1302/0301-620X.101B1.BJJ-2018-0869.R1.
The aim of this study was to evaluate the outcome of spinal instrumentation in haemodialyzed patients with native pyogenic spondylodiscitis. Spinal instrumentation in these patients can be dangerous due to rates of complications and mortality, and biofilm formation on the instrumentation.
A total of 134 haemodialyzed patients aged more than 50 years who underwent surgical treatment for pyogenic spondylodiscitis were included in the study. Their mean age was 66.4 years (50 to 83); 66 were male (49.3%) and 68 were female (50.7%). They were divided into two groups according to whether spinal instrumentation was used or not. Propensity score matching was used to attenuate the potential selection bias. The outcome of treatment was compared between these two groups.
A total of 89 patients (66.4%) underwent non-instrumented surgery and 45 (33.5%) underwent instrumented surgery. There were no significant differences in the rates of postoperative complications, except for an increased rate of wound problems in the instrumented group, which was found in the unmatched cohorts (p = 0.034). There were no significant differences in the rate of recurrent infections (p = 0.328 for the unmatched cohort; p = 0.269 for the matched cohort) and mortality rate, including in-hospital (p = 0.713 for the unmatched cohort; p = 0.738 for the matched cohort) and one-year rates (p = 0.363 for the unmatched cohort; p = 0.787 for the matched cohort), between the groups. However, the interval between the initial diagnosis and the first recurrence was significantly longer in the instrumented group (p = 0.008 for the unmatched cohort; p = 0.032 for the matched cohort).
Instrumented surgery for haemodialyzed patients with pyogenic spondylodiscitis showed similar outcomes, including recurrence and mortality, to non-instrumented surgery, despite the instrumented group having more severe neurological deficit, a larger number of involved levels, and increased kyphotic angle.
本研究旨在评估血液透析患者合并化脓性椎间盘炎时脊柱内固定的治疗效果。由于并发症发生率和死亡率较高，以及器械上生物膜的形成，此类患者进行脊柱内固定可能存在风险。
共纳入 134 例年龄大于 50 岁的血液透析患者，他们因化脓性椎间盘炎接受了手术治疗。这些患者的平均年龄为 66.4 岁（50 至 83 岁）；66 例为男性（49.3%），68 例为女性（50.7%）。根据是否使用脊柱内固定将他们分为两组。采用倾向评分匹配法来减轻潜在的选择偏倚。比较两组的治疗效果。
89 例（66.4%）患者接受了非器械固定手术，45 例（33.5%）患者接受了器械固定手术。除器械组术后伤口问题发生率较高外（未匹配队列中 p = 0.034），两组患者术后并发症发生率无显著差异。两组患者的复发性感染率（未匹配队列中 p = 0.328；匹配队列中 p = 0.269）和死亡率（未匹配队列中包括住院期间死亡率 p = 0.713；匹配队列中 p = 0.738）无显著差异，包括一年死亡率（未匹配队列中 p = 0.363；匹配队列中 p = 0.787）。然而，器械组的初次诊断与第一次复发之间的间隔时间显著长于非器械组（未匹配队列中 p = 0.008；匹配队列中 p = 0.032）。
尽管器械组患者的神经功能缺损更严重、受累节段更多、后凸角更大，但对于血液透析合并化脓性椎间盘炎的患者，与非器械手术相比，器械手术的治疗效果相似，包括复发率和死亡率。
