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Wihse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（viStlal 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m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±27．5rain），失血量为200—600ml（361．5±150．2m1）；后路手术时间为50。70min（57．7±8．3min），失血量为50～200ml（106．9±56．9m1）。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°±2．90°．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。
Objectives： To evaluate the clinical efficacy and clinical significance of one-stage anterior de- bridement and fusion combined with posterior fixation via Wiltse approach for the treatment of LS/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 pos- terior 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 infec- tions, 3 Eseheriehia 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.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2016年第9期827-832,共6页
Chinese Journal of Spine and Spinal Cord
关键词
一期前后路
腰椎前入路
Wiltse入路
腰椎间隙感染
One-stage anterior and posterior approach
Anterior of lumbar spine
Wihse approach
Lumbarpyogenic spondylodiscitis
