一期前路病灶清除植骨内固定术治疗颈椎间隙感染的临床研究

发布时间：2018-01-14 13:48

本文关键词：一期前路病灶清除植骨内固定术治疗颈椎间隙感染的临床研究　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨一期前路病灶清除植骨内固定术治疗颈椎间隙感染的临床疗效。方法:回顾性分析2010年6月至2014年6月我院行一期前路病灶清除植骨合内固定术治疗且获得完整随访的68例颈椎间隙感染患者的资料,男42例,女26例;年龄17~79岁,平均53.6岁。单间隙感染56例(C_(2/3) 3例,C_(3/4) 9例,C_(4/5) 15例,C_(5/6) 24例,C6/7 3例)、相邻双间隙感染12例(C_(2/3)和C_(3/4) 3例,C_(3/4)和C_(4/5) 2例,C_(4/5)和C_(5/6)7例)。术后依据诊断给予抗炎治疗,监测红细胞沉降率(erythrocyte sedimentation rate,ERS)及C-反应蛋白(C-reactive protein,CRP)评估感染控制情况。采用Eck融合和分级标准[10]评价植骨融合情况,临床疗效评价采用视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分(颈椎)。结果:68例患者均顺利完成手术,手术时间60-90min,平均70min;术中出血量30-150ml,平均88ml,诊断化脓性颈椎间隙感染14例,结核性颈椎间隙感染39例,布氏杆菌颈椎间隙感染8例,不明原因颈椎间隙感染7例。术后随访时间13~32个月,平均15.7个月。术后患者临床症状均明显缓解。颈部VAS评分术前平均5.3±2.7分,术后1月为2.3±2.5分,术后6月为0.9±1.6,末次随访为1.0±1.3分,术后颈部VAS评分较术前明显降低,差异有统计学意义(P0.05)。术前JOA评分平均10.8±3.5分,术后1月为13.4±4.7分,术后6月为15.6±3.6分,末次随访为15.9±2.5分;JOA改善率为78.4%。所有患者在随访期无内固定松动现象。术后有7例患者出现声嘶,给与甲钴胺片口服,随访观察一月后痊愈。2例患者术后2周内出现切口感染,经再次清创后痊愈。结论:一期前路病灶清除植骨内固定术治疗颈椎间隙感染可彻底清除病灶、解除神经压迫并提供坚强内固定,术后病理诊断及细菌培养可提供针对性的抗炎治疗,疗效确切,是一种良好的治疗方法。
[Abstract]:Objective: to investigate the clinical effect of one stage anterior debridement and bone grafting internal fixation in the treatment of cervical space infection. The data of 68 patients with cervical space infection who were treated with anterior debridement and bone grafting and internal fixation from June 2010 to June 2014 were analyzed retrospectively. 42 males and 26 females; The average age was 53.6 years, with 56 cases of single space infection (n = 56) and 3 cases with C / C / 3 / 4) 9 cases with C / C / 4 / 5 (n = 15). There were 24 cases of C6 / 7 / 7, 12 cases of contiguous double gap infection, and 3 cases of C / S / 3 / 4) and 3 cases of C / S 3 / 4) and 2 cases of C / S 4 / 5). Che 4 / 5) and Che 5 / 6 / 6 cases were treated with anti-inflammatory therapy according to the diagnosis after operation. Erythrocyte sedimentation rate and erythrocyte sedimentation rate were monitored. ERS) and C-reactive protein (CRP) were used to evaluate infection control. Eck fusion and grading criteria were used. [10] to evaluate the fusion of bone graft, visual analogue scale scale was used to evaluate the clinical efficacy. Japanese Orthopaedic Association Scores. Results all 68 patients were successfully operated, the operation time was 60-90 mins (mean 70 mins); The intraoperative bleeding volume was 30-150 ml (mean 88 ml). 14 cases were diagnosed as suppurative cervical space infection, 39 cases as tuberculous cervical space infection and 8 cases as brucellosis infection. The follow-up time was 13 ~ 32 months (mean 15.7 months). The clinical symptoms of the patients were obviously relieved. The average score of cervical VAS score was 5.3 卤2.7 before operation. The scores of postoperative VAS were 2.3 卤2.5 on January, 0.9 卤1.6 on June, and 1.0 卤1.3 on the last follow-up. The cervical VAS score was significantly lower than that before operation. The average JOA score was 10.8 卤3.5,13.4 卤4.7 in January and 15.6 卤3.6 in June. The last follow-up was 15.9 卤2.5 minutes. The improvement rate of JOA was 78.4%. There was no internal fixation loosening in all patients during the follow-up period. After operation, 7 patients developed hoarseness and were given mecoamin tablets orally. All patients were followed up for 2 weeks after January. The wound infection occurred in 2 weeks after operation and was cured after re-debridement. Conclusion: one stage anterior debridement and bone grafting and internal fixation can completely clear the focus of cervical intervertebral space infection. Relieving nerve compression and providing strong internal fixation, postoperative pathological diagnosis and bacterial culture can provide targeted anti-inflammatory treatment. It is a good treatment method.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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