颈椎射频消融术后颈椎感染的翻修手术治疗

Revision surgical treatment of cervical spine infection after radiofrequency ablation of cervical spine

中文关键词:  颈椎翻修手术  颈椎感染  颈椎射频消融

英文关键词:Cervical revision surgery  Cervical spine infection  Cervical spine radiofrequency ablation

中文摘要:

  【摘要】 目的：分析颈椎射频消融术后颈椎感染的翻修手术效果。方法：回顾性分析2010年7月~2016年7月在我科接受翻修手术的9例颈椎射频消融术后颈椎感染患者资料。其中男5例，女4例，年龄51.8±4.3岁（34~61岁），均在接受颈椎射频消融术后1周内（3~7d）神经症状再次出现或加重，其中5例患者神经症状加重程度超过射频消融术前，影像学检查和实验室检查提示存在颈椎感染，9例均存在椎间隙感染，3例伴有硬膜外脓肿，1例伴有椎体感染。入院后行翻修手术治疗，均行颈椎前路病灶清除+植骨融合内固定术，其中3例行椎体次全切除植骨融合内固定术，6例行椎间盘切除植骨融合内固定术。测量评估射频消融术前患者手术节段椎间隙的高度和椎间盘退变情况，用VAS评分评估患者翻修手术前后的颈部及上肢疼痛情况，用JOA评分评估翻修手术前后的神经功能情况。结果：射频消融术前，接受射频消融的11个节段椎间隙相对高度为0.19±0.07（0.14~0.25），Pfirrmann椎间盘退变分级为Ⅲ级4个节段、Ⅳ级7个节段。翻修术后所有患者颈部及上肢疼痛VAS评分及神经功能JOA评分较翻修术前明显改善（P<0.05）。平均随访2.8年（1~3.6年）。末次随访时，患者颈部及上肢VAS评分由翻修术前的6.3±1.2分和5.8±2.1分改善到1.6±1.0分和1.5±0.9分（P<0.05）；JOA评分从翻修术前的9.5±3.8分改善到13.5±3.6分（P<0.05）。随访期间未出现植骨不融合等其他并发症。结论：颈椎翻修手术是处理颈椎射频消融术后严重颈椎感染的有效方法。严格控制颈椎射频消融术适应证可以有效减少并发症发生。

英文摘要:

  【Abstract】 Objectives: To review the effects of revision surgery of cervical spine infection patients after radiofrequency ablation of cervical spine surgery. Methods: Nine patients with cervical spine infection after cervical radiofrequency ablation who underwent revision surgery were retrospectively analyzed from July 2010 to July 2016 in our department including 5 males and 4 females. The mean age was 51.8±4.3 years(34-61 years), the mean follow-up time was 2.8 years(1-3.6 years). All included patients had a recurrence or exacerbation of neurological symptoms within 1 week after receiving cervical radiofrequency ablation, five of whorm had more severe neurological symptoms than preoperative ones. Imaging studies and laboratory tests suggested the existence of cervical infection. Intervertebral space infections were presented in all 9 patients enrolled, concomitant with epidural abscesses in 3 patients and vertebral infection in 1 patient. Radiofrequency ablation before radiofrequency ablation of the 11 segments of the average relative height of 0.19±0.07(0.14-0.25) intervertebral disc, degeneration of grading as: grade Ⅲ in 4 segments, Ⅳ in 7 segments. Radiofrequency ablation surgery segment, postoperative symptom onset time, neurological function score were analyzed to evaluate the height of intervertebral space and disc degeneration in patients before radiofrequency ablation. Results: After radiofrequency ablation, the symptom of recurrence/exacerbation was a mean of 5 days (3-7 days). Five patients had worsening of neurological symptoms over radiofrequency ablation. All cases underwent preoperative cervical spine anterior debridement and bone graft reconstruction surgery. Three patients underwent total hip arthroplasty and grafting and internal fixation, and six patients underwent intervertebral discectomy and fusion fixation. VAS scores and neurological scores of neck and upper extremity pain in all patients after revision significantly improved than those before revision（P<0.05）. VAS scores (neck and upper extremity) at the final follow-up improved from 6.3±1.2 and 5.8±2.1 before revision to 1.6±1.0 and 1.5±0.9, respectively(P<0.05); JOA score improved from 9.5±3.8 before revision to 13.5±3.6(P<0.05). During the follow-up period, no other complications such as bone graft and non-fusion occurred. Conclusions: Cervical revision surgery is an effective method for the treatment of severe cervical spondylosis after cervical radiofrequency ablation. Strict control of cervical radiofrequency ablation indications can effectively reduce the incidence of complications.