一期前路病灶清除联合后路经S2骶髂关节螺钉内固定治疗腰骶椎感染

One-stage anterior debridement combined with posterior second sacral alar-iliac screw fixation for lumbosacral nonspecific infection

中文关键词:  腰骶椎  感染  经S2骶髂关节螺钉内固定  手术治疗

英文关键词:Lumbosacral infection  S2AI screw  Internal fixation  Surgical treatment

中文摘要:

  【摘要】 目的：评估一期前路病灶清除联合后路经S2骶髂关节螺钉内固定治疗腰骶椎感染的疗效。方法：回顾性分析2016年1月~2018年1月因腰骶椎感染行一期前路病灶清除联合后路经S2骶髂关节（second sacral alar-iliac，S2AI）螺钉内固定患者10例，男7例，女3例；年龄50~75岁，平均61.8±7.7岁。10例患者均系自发感染，其中3例合并糖尿病。所有患者均排除结核、布氏杆菌感染。所有患者术前完善白细胞计数、红细胞沉降率（erythrocyte sedimentation rate，ESR）以及C-反应蛋白（C-reactive protein，CRP）等检查。术前根据细菌培养及药敏试验结果应用抗生素。术后继续使用敏感抗生素，监测白细胞计数、ESR以及CRP以指导抗生素使用。记录手术时间、术中出血量、术前腰背痛视觉模拟评分（visual analogue scale，VAS）、术前腰椎JOA评分、末次随访VAS评分及JOA评分。影像学随访观察内固定及植骨融合情况。结果：10例患者均顺利完成手术，手术时间165~225min，平均193.5±20.6min，术中出血量为200~450ml，平均310.0±81.0ml。手术切口一期愈合。抗生素使用时间83~97d，平均89.2±4.5d。术后3个月时所有患者白细胞计数、ESR及CRP均降至正常。随访期间未发现感染复发的患者。腰背痛VAS评分由术前6.4±1.0分降至末次随访时的1.4±1.0分（P＜0.05），JOA评分由术前14.4±2.8分上升至末次随访时的24.3±2.9分（P＜0.05）。末次随访时，所有病例内固定位置良好，植骨区融合良好。结论：一期前路病灶清除联合后路S2AI螺钉固定治疗腰骶椎感染，可获得坚强的固定和满意的疗效。

英文摘要:

  【Abstract】 Objectives: To investigate the effect of one-stage anterior debridement combined with posterior second sacral alar-iliac(S2AI) screw fixation for lumbosacral nonspecific infection. Methods: The patients with lumbosacral infection who had undergone one-stage anterior debridement combined with posterior S2AI screw fixation from January 2016 to January 2018 were retrospectively analyzed. A total of 10 cases were enrolled in this study, consisting of 7 males and 3 females, with an average age of 61.8±7.7 years． All patients were spontaneously infected, of whom, 3 were complicated with diabetes mellitus. All patients were excluded from tuberculosis and Brucella infection. Leukocyte count, erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were collected in all patients before operation. Antibiotics were administered according to the results of bacterial culture and susceptibility test before operation. The administration of sensitive antibiotics was continued after operation. Leukocyte count, ESR and CRP were monitored to guide the use of antibiotics. The operation time, intraoperative blood loss, preoperative visual analogue scale(VAS), preoperative lumbar Japanese Orthopedic Association(JOA) score, final follow-up VAS score and JOA score were recorded. The results of internal fixation and bone graft fusion were observed. Results: All patients underwent the operation successfully. The operation time ranged from 165 to 225 minutes, with an average of 193.5±20.6 minutes. The intraoperative blood loss was 200-450ml, with an average of 310.0±81.0ml. The incision healed in one stage. The antibiotic use time was 83-97 days, with an average of 89.2±4.5 days. Leukocyte count, ESR and CRP decreased to normal levels 3 months after operation. No relapse of infection was found during follow-up. The average VAS score of low back pain decreased from 6.4±1.0 before operation to 1.4±1.0 at final follow-up(P<0.05), and the JOA score increased from 14.4±2.8 pre-operation to 24.3±2.9 at final follow-up(P<0.05). At final follow-up, bone graft fusion was good in all cases. Conclusions: One-stage anterior debridement combined with posterior S2AI screw fixation for lumbosacral infection can achieve rigid fixation and satisfactory results.