一期后路病灶清除植骨融合内固定闭式冲洗治疗原发性腰椎间隙感染

目的探讨一期后路病灶清除植骨融合内固定闭式冲洗治疗原发性腰椎间隙感染的有效性。方法回顾性分析2010年6月至2013年6月广州军区广州总医院收治的17例原发性腰椎间隙感染患者的临床资料,其中男10例,女7例;年龄12-77岁,平均年龄51岁。均为单一间隙感染,感染部位包括L2/32例、L3/45例、L4/58例、L5/S12例。均行一期后路病灶清除＋自体髂骨植骨融合内固定术,术中留取病灶组织标本进行细菌培养及病理学检查,术后持续闭式冲洗椎间隙2-3周。结果 17例患者均成功施行手术,术中失血量200-700mL,平均失血量（425±50）mL。病灶组织细菌培养结果：铜绿假单孢菌2例、金黄色葡萄球菌1例、粘质沙雷菌1例,余13例均为阴性;病理检查结果符合急慢性炎症表现。术后3周,降钙素原恢复正常,血常规、血沉、C反应蛋白均明显下降,3个月复查时恢复正常。切口均甲级愈合。术后随访6-42个月（平均28个月）,患者腰痛症状明显缓解,无感染复发病例。术后3-12个月（平均6.5个月）植骨均获骨性融合。结论一期后路病灶清除植骨融合内固定闭式冲洗治疗原发性腰椎间隙感染具有病灶清除彻底、固定可靠、操作简便可行、效果满意的特点,可使清除病灶、植骨、固定、冲洗一步到位,避免二次手术。

One-stage posterior debridement,grafting,internal fixation and continuously closed irrigation in the treatment of primary lumbar intervertebral infection

Objective To discuss the effectiveness of one-stage posterior debridement,grafting,internal fixation and continuously closed irrigation in the treatment of primary lumbar intervertebral infection.Methods Clinical data of17 patients with primary lumbar intervertebral infection treated in Guangzhou General Hospital of Guangzhou Military Command from June 2010 to June 2013 were retrospectively analyzed.There were 10 males and 7 females with an average age of 51 years（range,12-77 years）.All patients suffered from single lumbar intervertebral infection,including 2 patients at L2/3,5 at L3/4,8 at L4/5 and 2 at L5/S1.All 17 cases underwent one-stage posterior debridement,autogenous illiac bone grafting and internal fixation,tissue samples in focus were collected for bacterial culture and pathological examination during the operation,and then continuously closed irrigation was applied for 2-3 weeks postoperatively.Results All patients underwent the surgery successfully.The mean intraoperative estimate blood loss was（425 ± 50） mL（range,200-700 mL）.Results of bacterial culture showed pseudomonas aeruginosa in 2 cases,staphylococcus aureus in 1 case and serratia marcescens in 1 case,with other 13 cases of negative culture results;Pathological results indicated consistent with the menifestations of acute and chronic inflammation.At 3 weeks after the surgery,procalcitonin became normal,and parameters of routine blood test,erythrocyte sedimentation rate and C-reactive protein presented downtrend;Three months later,all above lab data came back to normal values.All incisions achieved primary healing.Seventeen patients were followed up from6 to 42 months（average,28 months）,and the symptom of pain relieved significantly.No recurrent infection had happened.A solid bony fusion was found in all patients at 3-12 months（average,6.5 months） after the surgery.Conclusion For patients with primary lumbar intervertebral infection,one-stage posterior debridement,grafting,internal fixation and continuously closed irrigati