Funayama Toru, Noguchi Hiroshi, Shibao Yosuke, Sato Kosuke, Kumagai Hiroshi, Miura Kousei, Takahashi Hiroshi, Tatsumura Masaki, Koda Masao, Yamazaki Masashi
Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan.
Departament of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 3003253, Japan.
J Artif Organs. 2023 Mar;26(1):89-94. doi: 10.1007/s10047-022-01335-2. Epub 2022 May 3.
An 81-year-old man was initially diagnosed with T11 osteoporotic vertebral fracture. The fractured vertebral body was filled with unidirectional porous beta-tricalcium phosphate (β-TCP) granules, and posterior spinal fixation was conducted using percutaneous pedicle screws. However, the pain did not improve, the inflammatory response increased, and bone destructive changes extended to T10. The correct diagnosis was pyogenic spondylitis with concomitant T11 fragility vertebral fracture. Revision surgery was conducted 2 weeks after the initial surgery, the T10 and T11 pedicle screws were removed, and refixation was conducted. After the revision surgery, the pain improved and mobilization proceeded. The infection was suppressed by the administration of sensitive antibiotics. One month after surgery, a lateral bone bridge appeared at the T10/11 intervertebral level. This increased in size over time, and synostosis was achieved at 6 months. Resorption of the unidirectional porous β-TCP granules was observed over time and partial replacement with autologous bone was evident from 6 months after the revision surgery. Two years and 6 months after the revision surgery, although there were some residual β-TCP and bony defect in the center of the vertebral body, the bilateral walls have well regenerated. This suggested that given an environment of sensitive antibiotic administration and restricted local instability, unidirectional porous β-TCP implanted into an infected vertebral body may function as a resorbable bone regeneration scaffold without impeding infection control even without debridement of the infected bony cavity.
一名81岁男性最初被诊断为T11骨质疏松性椎体骨折。骨折椎体填充单向多孔β-磷酸三钙（β-TCP）颗粒，并使用经皮椎弓根螺钉进行后路脊柱固定。然而，疼痛并未改善，炎症反应加重，骨质破坏改变扩展至T10。正确诊断为化脓性脊柱炎合并T11脆性椎体骨折。在初次手术后2周进行了翻修手术，取出T10和T11椎弓根螺钉并重新固定。翻修手术后，疼痛改善，患者开始活动。通过使用敏感抗生素抑制了感染。术后1个月，T10/11椎间水平出现外侧骨桥。随着时间推移其尺寸增大，6个月时实现了椎间融合。随着时间推移观察到单向多孔β-TCP颗粒吸收，翻修手术后6个月明显可见部分被自体骨替代。翻修手术后2年6个月，尽管椎体中心仍有一些残留的β-TCP和骨缺损，但双侧骨壁已良好再生。这表明在敏感抗生素给药和局部不稳定受限的环境下，植入感染椎体的单向多孔β-TCP即使在不清除感染骨腔的情况下也可作为可吸收骨再生支架发挥作用，且不妨碍感染控制。
