一期前路病灶清除植骨融合内固定治疗颈椎间隙化脓性感染

发布时间：2019-02-21 12:22

【摘要】：研究背景颈椎间隙化脓性感染疾病是颈椎间盘感染以及相邻软骨终板、椎体的化脓性感染病变。该病起病隐匿,发病率较低,较易被医师漏诊、误诊,临床主要表现为颈部疼痛、体温升高,椎间隙塌陷,颈椎序列不稳,反弓畸形,椎旁及椎管脓肿的出现还可以压迫脊髓或神经根产生神经根型疼痛及受压平面以下运动感觉障碍。长期、规范抗菌药物的应用是治疗颈椎间隙感染的主要治疗方法,但对于一些保守治疗失败、合并椎管脓肿,骨质破坏严重,神经受压严重的患者,可以对其进行手术治疗。手术治疗主要目的是彻底清除感染病灶(病变椎间盘、破坏的骨质、脓肿等)。颈前路病灶清除植骨融合钛板内固定术治疗颈椎间隙化脓性感染可以快速清除感染组织、减轻颈部疼痛,提高治愈率,重建颈椎正常的序列,维持颈椎稳定性,提高椎间融合率,减少并发症、降低感染复发风险。目的探讨一期前路病灶清除植入融合内固定治疗颈椎间隙化脓性感染的临床疗效。方法回顾性分析2010年10月至2014年12月收治的13例颈椎间隙化脓性感染疾病患者的病例资料,男11例,女2例,年龄45-62岁,平均53岁。所有患者均采用一期前路病灶清除、融合器植骨融合、钛板内固定治疗。术前术后均给予足量有效抗感染治疗不少于3月。所有患者均有颈肩部疼痛症状,术前疼痛视觉模拟量表(visual analogue scale,VAS)评分为5-10分,平均为7.5±1.4分;9例患者伴有不同程度的神经功能症状,日本骨科协会(Japanese Orthopaedic Association,JOA)颈椎评分标准评分为9-14分,平均为11.0±2.2分。结果所有患者均获得随访,随访时间为12-24个月,平均约15个。术后患者3月JOA评分为16.3±0.7,VAS评分为1.6±0.7,JOA与VAS与术前比较,差异有统计学意义。JOA优良率为88.9%。所有患者随访期间内固定无松动、断裂、脱落,椎间隙无塌陷,均骨性融合。所有手术切口均I级愈合,未见明显并发症,无感染复发。结论:一期前路病灶清除、融合器融合、钛板内固定、抗生素应用治疗颈椎间隙化脓性感染,能够取得良好效果。
[Abstract]:Background the suppurative infection of cervical intervertebral space is the infection of cervical intervertebral disc and adjacent cartilage endplate and vertebral body. The onset of the disease is hidden, the incidence is low, it is easy to be missed by doctors, misdiagnosed, the main clinical manifestations are neck pain, elevated body temperature, intervertebral space collapse, cervical spine sequence instability, reverse arch deformity. The presence of paraspinal and spinal canal abscess can also press the spinal cord or nerve root to produce radicular pain and sensorimotor disturbance below the compression level. For a long time, the application of standardized antimicrobial agents is the main treatment for cervical space infection, but for some conservative treatment failure, complicated with spinal canal abscess, serious bone destruction, serious nerve compression patients, can be surgical treatment. The main purpose of surgical treatment is to thoroughly remove infected lesions (diseased intervertebral disc, damaged bone, abscess, etc.). Anterior cervical debridement, bone grafting and titanium plate internal fixation in the treatment of suppurative infection in cervical space can quickly remove infected tissue, relieve neck pain, improve cure rate, reconstruct normal sequence of cervical vertebrae, and maintain cervical stability. To increase the rate of intervertebral fusion, reduce complications and reduce the risk of infection recurrence. Objective to investigate the clinical effect of one-stage anterior debridement, fusion and internal fixation in the treatment of suppurative infection in cervical intervertebral space. Methods from October 2010 to December 2014, 13 patients with suppurative infection of cervical intervertebral space were retrospectively analyzed. 11 males and 2 females, aged 45-62 years, with an average age of 53 years, were analyzed. All patients were treated with one-stage anterior debridement, fusion with fusion cage and titanium plate fixation. All patients were given effective anti-infective therapy before and after operation for no less than 3 months. All patients had neck and shoulder pain symptoms, preoperative pain visual analogue scale (visual analogue scale,VAS) score was 5-10 points, average 7.5 卤1.4 points; In 9 patients with neurologic symptoms of varying degrees, the cervical spine score of the Japanese Orthopaedic Association (Japanese Orthopaedic Association,JOA) was 9-14, with an average score of 11.0 卤2.2. Results all patients were followed up for 12-24 months with an average of 15. At 3 months after operation, the JOA score of the patients was 16.3 卤0.7 and VAS was 1.6 卤0.7, the difference was statistically significant, and the excellent and good rate of JOA was 88.9. There was no loosening, fracture, exfoliation, no collapse in intervertebral space and bony fusion in all patients. All incisions healed in grade I without obvious complications and no recurrence of infection. Conclusion: one stage anterior debridement, fusion of fusion cage, titanium plate fixation and antibiotic therapy for suppurative infection in cervical intervertebral space can achieve good results.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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