一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染

L5/S1 pyogenic spondylodiscitis treated with anterior debridement and fusion combined with posterior fixation via Wiltse approach

中文关键词:  一期前后路  腰椎前入路  Wiltse入路  腰椎间隙感染

英文关键词:One-stage anterior and posterior approach  Anterior of lumbar spine  Wiltse approach  Lumbar pyogenic spondylodiscitis

中文摘要:

  【摘要】 目的：探讨一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染的临床疗效及意义。方法：回顾性分析2011年3月～2015年1月我院收治并应用一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗的13例L5/S1椎间隙感染患者，其中男8例，女5例；年龄28～60岁（41.6±11.0岁）；记录患者术中手术时间、出血量、术后并发症，记录术前、术后腰部疼痛视觉模拟评分（visual analogue scale，VAS）评估临床症状，术前术后腰骶角（lumbosacral angle，LSA）评估腰骶段前凸恢复情况。结果：所有手术均顺利完成，手术后1例出现逆行性射精，1例患者发生单侧下肢肌间静脉血栓，未出现严重并发症；前路手术时间为70~120min（90.0±27.5min），失血量为200~600ml（361.5±150.2ml）；后路手术时间为50~70min（57.7±8.3min），失血量为50~200ml（106.9±56.9ml）。术后培养结果其中7例为金黄色葡萄球菌感染，3例为大肠杆菌，1例为铜绿假单胞菌，2例未见细菌生长，但病理检查结果提示感染性病变。病例均获随访，时间6~30个月（16.6±7.8个月）。末次随访时所有患者均达临床愈合，骨融合率100%，随访期内未见复发病例。VAS评分术前平均7.8±0.7分，术后6个月平均1.3±0.5分，与术前比较差异有统计学意义（P<0.05）；LSA术前4.4°±2.9°，末次随访时17.5°±2.8°，与术前比较有统计学意义（P<0.05）。结论：一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染的手术创伤小、固定可靠、疗效确切，可以作为治疗L5/S1椎间隙感染的一种手术方法。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacy and clinical significance of one-stage anterior debridement and fusion combined with posterior fixation via Wiltse approach for the treatment of L5/S1 pyogenic spondylodiscitis. Methods: Thirteen patients with L5/S1 pyogenic spondylodiscitis treated in our institution by one-stage anterior debridement and fusion combined with posterior fixation via Wiltse approach from March 2011 to January 2014 were included, there were 8 males and 5 females． The ages of patients were from 28 to 60(41.6±11.0) years. The operation time, blood loss, postoperative complications, visual analogue scale(VAS) and lumbosacral angle(LSA) were recorded. Results: All patients were followed up for 6-30 months with an average time of 16.6±7.8 months． There were no severe complications during and after operation except of a case of retrograde ejaculation and deep venous thrombosis. The anterior operation time was 90.0±27.5 minutes in average(range, 70-120min), and the blood loss was 361.5±150.2ml in average(range, 200-600ml)． The posterior operation time was 57.7±8.3 minutes in average(range, 50-70min), and the blood loss was 106.9±56.9ml in average(range, 500-200ml)． According to the culture findings, there were 7 Staphylococcus aureus infections, 3 Escherichia coli infections, 1 Pseudomonas aeruginosa infection and negative in 2 cases. All patients reached clinical healing, no recurrence during follow-up was noted. The fusion rate was 100％ at postoperation． VAS was 7．8±0．7 at preoperation while 1．3±0．5 at 6 months of postoperation(P<0．05). The LSA was 4.4°±2.9° at preoperation, while it was 17.5°±2.8° at the final follow-up, the difference was statistically significant(P<0．05). Conclusions: One-stage anterior debridement and fusion combined with posterior fixation via Wiltse approach is a safe and effective surgery in the treatment of L5/S1 pyogenic spondylodiscitis, it is with less surgery injury, easy operative procedure, reliable clinical results．