徐 勇,李 锋,熊 伟,方 忠,廖 晖.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[J].中国脊柱脊髓杂志,2016,(9):827-832. |
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 |
中文关键词: 一期前后路 腰椎前入路 Wiltse入路 腰椎间隙感染 |
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。 |
L5/S1 pyogenic spondylodiscitis treated with anterior debridement and fusion combined with posterior fixation via Wiltse approach |
英文关键词:One-stage anterior and posterior approach Anterior of lumbar spine Wiltse approach Lumbar pyogenic spondylodiscitis |
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. |
投稿时间:2016-07-16 修订日期:2016-09-02 |
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