Service de Médecine Interne, Hôpital Beaujon, Assistance Publique-Hôpitaux Paris Nord, Clichy, France.
Service de Chirurgie Orthopédique, Hôpital Beaujon, Assistance Publique-Hôpitaux Paris Nord, Clichy, France.
Infect Dis (Lond). 2020 Aug;52(8):563-570. doi: 10.1080/23744235.2020.1767299. Epub 2020 May 20.
Whether surgery modalities vary according to kinetics of pathological processes responsible for vertebral osteomyelitis (VO) is unclear. We therefore compared surgical modalities in patients with haematogenous pyogenic VO (HPVO) or tuberculous VO (TVO). Patients who had surgery for HPVO or TVO between January 1997 and June 2018 in a university hospital were included. Surgical indications, timing, and procedures and outcomes were evaluated at the end of treatment. Seventy-eight patients (50 men) were included: 39 with HPVO and 39 with TVO; median age was 64 and 41 years, respectively. In patients with HPVO, surgery was performed early: 17 (44%) had surgery within 72 h of admission; main indication for surgery was neurological deficit in 29 patients that persisted in 12 patients (27%). In patients with TVO, surgery was performed later (<.001), after two weeks in 20 patients (51%), and was indicated by a neurological deficit in 23 patients; among them, only one (4%) had residual deficit. Different kinetic profiles of the infectious processes explain the more rapid indication for surgery in patients with HPVO and the more favourable neurological recovery in patients with TVO.
导致椎体骨髓炎（VO）的病理过程的动力学是否会影响手术方式尚不清楚。因此，我们比较了血源性化脓性 VO（HPVO）和结核性 VO（TVO）患者的手术方式。纳入 1997 年 1 月至 2018 年 6 月期间在一所大学医院接受手术治疗的 HPVO 或 TVO 患者。在治疗结束时评估手术适应证、时机、手术过程和结果。共纳入 78 例患者（50 例男性）：39 例 HPVO，39 例 TVO；HPVO 患者的中位年龄为 64 岁，TVO 患者的中位年龄为 41 岁。HPVO 患者的手术时间较早：17 例（44%）在入院后 72 小时内进行手术；29 例患者存在持续性神经功能缺损，其中 12 例（27%）为主要手术适应证。TVO 患者的手术时间较晚（<0.001），20 例（51%）在两周后进行手术，23 例患者的手术适应证为神经功能缺损；其中只有 1 例（4%）存在残留缺损。不同的感染过程动力学特征解释了 HPVO 患者手术指征更快以及 TVO 患者神经功能恢复更好的原因。
