颈椎前路清创融合术治疗颈椎化脓性椎间盘炎：是否使用前路钢板？
Anterior Cervical Debridement and Fusion for Cervical Pyogenic Spondylodiscitis: Use of Anterior Cervical Plating or Not?
机构信息
Department of Orthopaedic Surgery, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea.
Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
出版信息
Spine (Phila Pa 1976). 2020 Apr 1;45(7):431-437. doi: 10.1097/BRS.0000000000003298.
STUDY DESIGN
Retrospective multicenter case series.
OBJECTIVE
We sought to evaluate the safety and efficacy of anterior cervical plating in anterior cervical debridement and fusion (ACDF) for patients with cervical pyogenic spondylodiscitis (CPS).
SUMMARY OF BACKGROUND DATA
Due to concerns about bacterial seeding on the foreign material after instrumentations in pyogenic infections, the safety and efficacy of anterior cervical plating for CPS are still undetermined and controversial. Little information is available about the safety and efficacy of anterior cervical plating to manage CPS.
METHODS
Twenty-three patients who underwent ACDF with (n = 12) or without (n = 11) plating for CPS were included. The mean age was 62.6 years. Medical records were reviewed and radiological parameters including segmental height, segmental angle, C2-C7 angle, and fusion status were analyzed. The mean follow-up period after surgery was 21.3 months.
RESULTS
After ACDF with plating, segmental height, segmental angle, and C2-C7 angle were significantly improved compared with preoperative conditions and remained well-maintained at the last follow-up. After ACDF without plating, three radiological parameters were also initially improved compared with preoperative condition, but significantly deteriorated to preoperative levels at the time of the last follow-up. The fusion rate was higher in the ACDF with plating group compared with the ACDF without plating group (90.9% vs. 63.6%; P < 0.01). One patient who received ACDF with plating and four patients who received ACDF without plating underwent revision surgery due to nonunion or bone graft dislodgement. No recurrence of pyogenic spondylodiscitis occurred in either group.
CONCLUSION
ACDF with plating showed better surgical outcomes compared with ACDF without plating for CPS. We recommend the use of anterior cervical plating, which can provide biomechanical stability, for better healing of CPS. To our knowledge, this is the largest surgical case series of CPS.
LEVEL OF EVIDENCE
研究设计
回顾性多中心病例系列研究。
目的
我们旨在评估前路颈椎板在颈椎化脓性脊椎炎（CPS）前路颈椎清创融合术（ACDF）中的安全性和有效性。
背景资料概要
由于在化脓性感染的器械后担心细菌播种到异物上，前路颈椎板在 CPS 中的安全性和有效性仍不确定，存在争议。关于前路颈椎板治疗 CPS 的安全性和有效性的信息很少。
方法
共纳入 23 例接受 ACDF 治疗的 CPS 患者（前路颈椎板固定组，n=12；前路颈椎板非固定组，n=11）。患者的平均年龄为 62.6 岁。回顾病历资料，并分析包括节段高度、节段角度、C2-C7 角和融合状态在内的影像学参数。术后平均随访时间为 21.3 个月。
结果
前路颈椎板固定组在 ACDF 术后，节段高度、节段角度和 C2-C7 角与术前相比显著改善，且在末次随访时保持良好。前路颈椎板非固定组在 ACDF 术后，三个影像学参数也与术前相比最初有所改善，但在末次随访时显著恶化至术前水平。前路颈椎板固定组的融合率明显高于前路颈椎板非固定组（90.9% vs. 63.6%；P<0.01）。前路颈椎板固定组中有 1 例患者和前路颈椎板非固定组中有 4 例患者因骨不连或植骨移位而行翻修手术。两组均未出现化脓性脊椎炎复发。
结论
与前路颈椎板非固定组相比，前路颈椎板固定组治疗 CPS 的手术效果更好。我们建议使用前路颈椎板固定，这可以为 CPS 的更好愈合提供生物力学稳定性。据我们所知，这是 CPS 最大的手术病例系列研究。
证据等级
4 级。
Zotero 插件