[1]陈树东 李永津 杜炎鑫 苏国义 侯 宇 陈博来△.经皮内镜病灶清除及灌洗引流治疗腰椎间隙感染15例[J].中国中医骨伤科杂志,2018,26(08):59-62.
点击复制

经皮内镜病灶清除及灌洗引流治疗腰椎间隙感染15例()
分享到:

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第26卷
期数:
2018年08期
页码:
59-62
栏目:
临床报道
出版日期:
2018-08-02

文章信息/Info

文章编号:
1005-0205(2018)08-0059-04
作者:
陈树东1 李永津1 杜炎鑫1 苏国义1 侯 宇1 陈博来1△
1广东省中医院骨一科(广州,510120) 通信作者 E-mail:chenbolai337@163.com
关键词:
经皮内镜 感染 微创
分类号:
R681.5
文献标志码:
B
摘要:
目的:探讨经皮内镜病灶清除及灌洗引流治疗腰椎间隙感染的有效性及安全性。方法:回顾性分析2015年6月至2017年12月因腰椎间隙感染于本院住院部行该术式的15例患者,记录患者影像学表现、实验室检查结果及VAS评分,运用改良Macnab疗效评定标准评价疗效。结果:15例患者中男10例,女5例; 年龄(54.5±10.0)岁,L1S1各节段均有发病,其中13例单节段发病、2例连续双节段发病。术前均有腰痛,伴或不伴有臀部及下肢放射痛、麻木、乏力等症状。入院前7例有发热史,2例在血培养中发现细菌,4例近期行手术史。入院后2例患者在血培养中发现细菌。15例患者均顺利行病灶清除,手术用时(1.9±0.5)h,5例留置灌洗引流装置,无并发症发生。术后标本涂片或培养4例发现细菌。2例L3~4节段患者因后期疼痛症状反复于术后2周内行腰椎融合术。住院时间(21.4±10.2)d,所有患者术后疼痛、麻木、乏力症状均较术前改善,术前VAS评分(5.8±1.4)分,出院VAS评分(1.4±0.7)分,差异有统计学意义(t=2.14,P<0.05)。术后随访(8.9±4.0)个月,影像学可见病灶炎症吸收、椎间骨性融合,炎症指标恢复正常。末次随访时改良Macnab疗效评定标准:优11例,良2例,可2例,差0例。结论:经皮内镜病灶清除及灌洗引流治疗腰椎间隙感染具有微创的优点,能够直接清除病灶,获取足量病灶组织进行病检,缩短治疗周期,促进患者快速康复。

参考文献/References:

[1] Przybylski GJ, Sharan AD.Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis[J].J Neurosurg, 2001, 94(1 Suppl):1-7. [2] Cheung WY, Luk KD.Pyogenic spondylitis[J].Int Orthop, 2012, 36(2):397-404. [3] Bhagat S, Mathieson C, Jandhyala R, et al.Spondylodiscitis(disc space infection)associated with negative microbiological tests:comparison of outcome of suspected disc space infections to documented non-tuberculous pyogenic discitis[J].Br J Neurosurg, 2007, 21(5):473-477. [4] Heyer CM, Brus LJ, Peters SA, et al.Efficacy of CT-guided biopsies of the spine in patients with spondylitis-an analysis of 164 procedures[J].Eur J Radiol, 2012, 81(3):e244-249. [5] 徐良志, 谢恩, 郝定均, 等.椎间隙改良穿刺抽吸活检对腰椎化脓性椎间盘炎的诊断价值[J].中国脊柱脊髓杂志, 2014,24(8):734-737. [6] Yang SC, Fu TS, Chen LH, et al.Identifying pathogens of spondylodiscitis:percutaneous endoscopy or CT-guided biopsy[J].Clin Orthop Relat Res, 2008, 466(12):3086-3092. [7] Chew FS, Kline MJ.Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious diskitis[J].Radiology, 2001, 218(1):211-214. [8] Fraser RD, Osti OL, Vernon-Roberts B.Iatrogenic discitis:the role of intravenous antibiotics in prevention and treatment.an experimental study[J].Spine(Phila Pa 1976), 1989, 14(9):1025-1032. [9] Verdu-Lopez F, Vanaclocha-Vanaclocha V, Mayorga-Villa JD.Minimally invasive spine surgery in spinal infections[J].J Neurosurg Sci, 2017, 61(3):303-315. [10] Jaramillo-de la Torre JJ, Bohinski RJ, Kuntz Ct.Vertebral osteomyelitis[J].Neurosurg Clin N Am, 2006, 17(3):339-351. [11] Stuer C, Stoffel M, Hecker J, et al.A staged treatment algorithm for spinal infections[J].J Neurol Surg A Cent Eur Neurosurg, 2013, 74(2):87-95. [12] Akbar M, Lehner B, Doustdar S, et al.Pyogenic spondylodiscitis of the thoracic and lumbar spine:a new classification and guide for surgical decision-making[J].Orthopade, 2011, 40(7):614-623. [13] Lener S, Hartmann S, Barbagallo GMV, et al.Management of spinal infection:a review of the literature[J].Acta Neurochir(Wien), 2018, 160(3):487-496. [14] Tschugg A, Hartmann S, Lener S, et al.Minimally invasive spine surgery in lumbar spondylodiscitis:a retrospective single-center analysis of 67 cases[J].Eur Spine J, 2017, 26(12):3141-3146. [15] Fu TS, Chen LH, Chen WJ.Minimally invasive percutaneous endoscopic discectomy and drainage for infectious spondylodiscitis[J].Biomed J, 2013, 36(4):168-174. [16] Yang SC, Fu TS, Chen HS, et al.Minimally invasive endoscopic treatment for lumbar infectious spondylitis:a retrospective study in a tertiary referral center[J].BMC Musculoskelet Disord, 2014, 15(1):105. [17] Ito M, Abumi K, Kotani Y, et al.Clinical outcome of posterolateral endoscopic surgery for pyogenic spondylodiscitis:results of 15 patients with serious comorbid conditions[J].Spine(Phila Pa 1976), 2007, 32(2):200-206. [18] Nagata K, Ohashi T, Ariyoshi M, et al.Percutaneous suction aspiration and drainage for pyogenic spondylitis[J].Spine(Phila Pa 1976), 1998, 23(14):1600-1606. [19] Hadjipavlou AG, Katonis PK, Gaitanis IN, et al.Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis[J].Eur Spine J, 2004, 13(8):707-713. [20] Hanaoka N, Kawasaki Y, Sakai T, et al.Percutaneous drainage and continuous irrigation in patients with severe pyogenic spondylitis, abscess formation, and marked bone destruction[J].J Neurosurg Spine, 2006, 4(5):374-379. [21] Tofuku K, Koga H, Yone K, et al.Continuous irrigation in pyogenic spondylitis accompanied by iliopsoas abscess[J].Spine(Phila Pa 1976), 2007, 32(14):E382-387. [22] 孙海涛, 关家文, 马宗雷, 等.CT引导经皮脊柱内窥镜病灶清除加置管治疗胸腰椎脊柱感染[J].中国骨与关节损伤杂志, 2015,30(3):266-268. [23] Choi EJ, Kim SY, Kim HG, et al.Percutaneous endoscopic debridement and drainage with four different approach methods for the treatment of spinal infection[J].Pain Physician, 2017, 20(6):E933-E940. [24] 张西峰, 王岩, 王继芳, 等.经皮病灶清除持续灌注冲洗治疗腰椎间隙感染[J].中国矫形外科杂志, 2003,11(20):1327-1329. [25] Yang SC, Chen WJ, Chen HS, et al.Extended indications of percutaneous endoscopic lavage and drainage for the treatment of lumbar infectious spondylitis[J].Eur Spine J, 2014, 23(4):846-853.

更新日期/Last Update: 2018-08-02