腰椎射频消融髓核成形术后椎间隙感染的临床表现及治疗策略

目的:探讨经皮穿刺腰椎射频消融髓核成形术后椎间隙感染的临床表现及治疗措施。方法:对2009年6月至2019年6月使用低温等离子射频消融髓核成形技术进行经皮腰椎椎间盘减压术496例患者回顾性分析,其中6例出现椎间隙感染,总感染率1.21%;均为男性,年龄20～61岁,平均33.7岁;接受单节段射频消融3例,双节段2例,3节段1例,共计10个椎间盘。1例术前合并2型糖尿病。感染发生间隔时间21～65 d。结果:6例均获得随访,时间18～40个月,平均24个月。其中2例出现腰背痛伴发热症状,影像学检查可见椎间隙感染伴脓肿;另外4例出现腰背痛但无发热症状,MRI可见感染椎间隙终板或椎体异常信号。1例血液培养出沃氏葡萄球菌,其余5例细菌培养阴性。6例确诊后均给予抗生素治疗,4例经过保守治疗感染控制,1例行腰椎后路感染病灶清理手术,1例行腰椎后路感染病灶清理+椎间植骨融合内固定手术。结论:腰椎射频消融髓核成形术发生椎间隙感染应该引起足够重视。严格无菌操作,避免多节段反复穿刺,做到早发现、早治疗,根据感染的严重程度选择合适的治疗方法是取得疗效的保证。

Clinical manifestation and treatment strategy of intervertebral space infection after radiofrequency ablation of lumbar nucleus pulposus

Objective To study the clinical manifestations and treatment of intervertebral space infection after percutaneous lumbar radiofrequency ablation of nucleus pulposus.Methods A retrospective analysis was performed of 496 patients who underwent percutaneous lumbar disc decompression using low-temperature plasma radiofrequency ablation nucleus pulposus from June 2009 to June 2019. Six patients had lumbar infection,and the infection rate was 1.21%. All patients were male,ranging in age from 20 to 61 years old. Three patients underwent single segment radiofrequency ablation,two patients underwent dual segments ablation;and one patient underwent three segment ablation,totaling 10 intervertebral discs. One patient was complicated with type 2 diabetes before operation. The interval between infection occurrence ranged from 21 to 65 days.Results All 6 patients were followed up,and the duration ranged from 18 to 40 months,with an average of 24 months. Among them,2 patients presented with symptoms of low back pain accompanied by fever,and imaging examination showed intervertebral space infection accompanied by abscess. In addition,4 patients experienced low back pain but no fever,and MRI showed abnormal signals of the infected intervertebral endplate or vertebral body. One patient showed staphylococcus aureus in blood culture,while the remaining 5 patients showed negative bacterial culture. All the patients were treated with antibiotics after diagnosis. Four patients were treated with conservative management to control infection;1 patient was treated with debridement of posterior lumbar infection focus,and 1 patient was treated with debridement of posterior lumbar infection focus combined with interbody fusion and internal fixation.Conclusion The occurrence of intervertebral space infection during lumbar radiofrequency ablation nucleoplasty should be given sufficient attention. Strict aseptic technique,avoiding repeated multi segment puncture,realizing early detection and treatment,and selecting appropriate treatment methods according to the severity of infection is the guarantee of achieving curative effect.