一期前路病灶清除植骨融合内固定术治疗下颈椎化脓性骨髓炎

Surgical management of one-stage anterior debridement and fusion for pyogenic osteomyelitis of the lower cervical spine

中文关键词:  化脓性骨髓炎  颈椎  融合术  自体植骨  前路  内固定

英文关键词:Pyogenic osteomyelitis  Cervical spine  Fusion  Autograft  Anterior approach  Interfixation

中文摘要:

  【摘要】 目的：探讨一期前路病灶清除、感染椎体次全切、自体髂骨植骨融合、钛板固定术治疗下颈椎化脓性骨髓炎的疗效。方法：2004年1月至2009年6月共收治17例下颈椎化脓性骨髓炎患者，男性14例，女性3例；年龄42~78岁，平均56.5岁。17例患者均有颈痛，9例伴发热，6例伴脊髓损伤，5例伴神经根性损伤。影像学检查13例有硬膜外脓肿形成，4例椎前脓肿形成伴椎体广泛破坏。均于广谱或敏感抗菌素治疗7~14d后行一期前路病灶清除、感染椎体次全切除、自体髂骨植骨融合、钛板内固定术。术后抗菌素治疗12~14周，定期复查血白细胞计数、血沉和C反应蛋白、颈椎正侧位X线片及CT，术后12个月行MRI检查。结果：手术时间50~150min，平均110min，术中无血管及神经损伤发生；术后2例切口浅层感染，经换药后愈合，无食管漏等严重并发症发生。所有患者于术后1周内颈痛缓解，体温恢复正常。13例于术后12周前白细胞计数、血沉、C反应蛋白均降至正常；4例白细胞计数正常，但血沉及C反应蛋白至术后9个月才降至正常。所有患者于术后12个月复查CT，16例植骨融合；1例融合失败，24个月随访时假关系形成。随访18~24个月，平均20.3个月，术前有脊髓和神经根损伤患者神经功能均完全恢复正常，感染均无复发。结论：在规范、有效、充分的围手术期抗菌素治疗期间行一期前路病灶清除、感染椎体次全切除、自体髂骨植骨融合、钛板内固定术是治疗下颈椎化脓性骨髓炎的有效方法。

英文摘要:

  【Abstract】 Objective：To investigate the clinical results of surgical management of one-stage anterior debridement and fusion for pyogenic osteomyelitis of the lowercervical spine.Method：A retrospective study of 17 consecutive patients between Junuary 2004 and June 2009 treated surgically due to cervical pyogenic osteomyelitis was performed.There were 14 males and 3 females with the mean age at the time of surgery of 56.5 years（range，42-78）.9 cases presented with fever，6 cases with neurological deficits，while 5 cases with radiculopathy.All 17 cases presented with neck pain.13 cases had presence of epidural purulence，and the other 4 cases had prevertebral abscess combined with general vertebral collapse under preoperative MRI.Intravenous broad-spectrum antibiotics for 7-14 days were used prior to operation.All the patients underwent one-stage anterior debridement，vertebral corpectomy and auto iliac crest bone graft and fusion even in the presence of purulence.Periodic check of WBC，ESR，CRP and A-P and lateral radiographic film and CT scan of cervical spine was performed after operation.All cases underwent MRI at the time of the 12th month after operation.Result：The operation time was 50-150min（mean，110min）.No neurovascular injury was noted.All cases were followed-up for a mean of 20.3 months.Healing of the infection was confirmed in all cases by laboratorial，clinical and radiological tests.13 cases had WBC，ESR，CRP returned to normal in less than 12 weeks after operation；while the other 4 cases had them still abnormal until 9 months after operation.All cases had fever and neck pain relieved completely in less than 1 week after operation.16 cases had bony fusion evidenced under CT scan in less than 12 months，and 1 case developed into pseudarthrosis at the 24th month.Preoperative neurological deficits improved in all cases.6 cases with preoperative incomplete quadriplegia or paraplegia（Frankel C and D） achieved normal function（Frankel E）.5 cases with radiculopathy had symptom relieved completely.No infection recurrence was noted during follow-up.Conclusion：One-stage anterior debridement，vertebral corpectomy and auto iliac crest bone graft and fusion combined with routine and adequate perioperative antibiotic administration is reliable and effective for pyogenic osteomyelitis in cervical spine even in the presence of purulence.