Chinese Journal of Tissue Engineering Research ›› 2019, Vol. 23 ›› Issue (14): 2133-2139.doi: 10.3969/j.issn.2095-4344.1662
Yao Liquan, Ling Qinjie, Li Jiaying, Zhong Letian, Zhou Xingping, Liu Jintao, He Erxing, Yin Zhixun
Received:
2018-12-26
Contact:
He Erxing, Master, Chief physician, Department of Spinal Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China
About author:
Yao Liquan, Master, Department of Spinal Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China
Supported by:
the Science and Technology Program of Department of Science and Technology of Guangdong Province, No. 2014A020212369 (to YZX); the Applied Basic Project of Science and Technology Bureau of Guangzhou, No. 2013J4100041 (to YZX)
CLC Number:
Yao Liquan, Ling Qinjie, Li Jiaying, Zhong Letian, Zhou Xingping, Liu Jintao, He Erxing, Yin Zhixun. Antibiotic artificial bone implantation for treating pyogenic spondylodiscitis[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(14): 2133-2139.
2.2 治疗结果 31例患者均顺利完成手术(24例经椎板间隙入路,7例经斜侧椎间孔入路),所有患者术后腰痛及下肢放射痛得到即刻缓解。手术时间(134±19) min,术中出血量(98±22) mL。所有病例术中均见病变椎间盘呈炎症坏死样改变,椎间隙不同程度变窄,并伴相邻终板及椎体终板下骨质不同程度的破坏。6例术中切开病变椎间盘纤维环,可见少量黄白色脓液流出;2例术中可见椎管内硬膜外脓肿病灶;5例患者术中可见脱出椎间盘髓核压迫硬脊膜囊及神经根,均顺利被清除。31例患者病理结果均显示椎间盘组织及软骨终板呈炎症性坏死改变,可见大量中性粒细胞、浆细胞浸润及部分变性坏死细胞。 细菌培养结果:革兰阳性菌中金黄色葡萄球菌5例,表皮葡萄球菌3例,白色葡萄球菌1例,无乳链球菌(B群)1例;革兰阴性菌中大肠埃希菌2例;培养阴性19例。 2.3 治疗效果 该手术方式通过内镜工作通道直接经椎间孔到达椎间隙进行病灶清除,无需剥离椎旁肌,创伤小,内镜直视下更好的保护神经根及硬脊膜囊,且术中保留棘突、椎板及一侧完整关节突关节,若通过后外侧入路经Kambin三角进入椎间隙,可完整保留患者脊柱骨性结构,联合椎弓根螺钉固定,保持了脊柱稳定性。椎间植入抗生素硫酸钙人工骨,可提高并维持局部抗生素浓度,有效控制感染病灶。 所有病例手术过程中均无硬脊膜及神经根损伤,术后患者疼痛即刻减轻,术后1-4 d均可佩戴腰围下地活动,平均下地时间为(2.00±0.95) d,下地活动后即可进行适度腰背肌锻炼;31例患者手术切口均一期愈合,术后5-10 d腰腿痛消失并顺利出院。2例出现单侧下肢趾背伸肌力下降患者,术前为2级,出院时趾背伸肌力均恢复至3+级,末次随访均恢复至4级。 2.4 随访结果及观察指标 实验室指标:31例术前血沉平均为(62.45±25.62) mm/h,术后第1天复查血沉平均为(69.25±24.23) mm/h,术后1周血沉明显下降,平均为(24.22±7.14) mm/h,术后1个月全部恢复正常;术前C-反应蛋白平均为(80.5±27.3) mg/L,术后第1天复查C-反应蛋白平均为(95.1±33.3) mg/L,术后1周明显下降,平均为(18.9±7.2) mg/L,术后1个月全部恢复正常。所有患者术后第3,6个月复查血沉及C-反应蛋白均正常。 目测类比评分及JOA评分:30例患者术后术后1周、末次随访时的目测类比评分及JOA评分与术前比较差异有显著性意义(P < 0.05),见表2。末次随访时JOA改善率,优90%(28例),良10%(3例)。"
2.6 典型病例 63岁女性患者,既往有乳腺癌病史,因“腰骶部疼痛1个月、双下肢放射痛2周”入院,入院诊断:L4/5化脓性椎间盘炎;右乳腺癌改良根治术后。患者入院体温38.9 ℃,腰背部疼痛明显,L4-5棘突及椎旁肌肉压痛阳性,伴双侧臀部及双侧大腿后外侧放射性疼痛,肌力、感觉均正常,生理反射存在,病理反射未引出。入院后查血常规:白细胞13.4×109 L-1,中性粒细胞83%,血沉128 mm/h,C-反应蛋白63.6 mg/L,降钙素原正常。术前目测类比评分8分,JOA评分6分。 患者入院后行L4、5椎体及L4/5椎间盘穿刺活检术,病例结果提示送检组织炎症性病理改变,培养结果提示无乳链球菌(B群)感染。入院完善术前检查评估后予后路内镜下病灶清除、抗生素人工骨植入联合一期L3/S1经皮椎弓根螺钉内固定术,术中取标本送病理检查及进行细菌培养,术程顺利,术中手术时间出血50 mL。术后第1天血常规:白细胞12.7×109 L-1,中性粒细胞76%,血沉65 mm/h,C-反应蛋白20.9 mg/L,降钙素原正常,目测类比评分2分,JOA评分19分。术后1周血常规:白细胞8.64×109 L-1,中性粒细胞65%,血沉21 mm/h,C-反应蛋白10.3 mg/L,降钙素原正常;目测类比评分1分,JOA评分26分。术后1个月血常规、血沉及C-反应蛋白均回复正常,目测类比评分1分,JOA评分28分。术后病理结果提示炎性组织改变,中性粒细胞浸润;培养结果提示无乳链球菌(B群)感染。术后根据药敏结果予敏感抗生素莫西沙星治疗。患者术后腰腿疼痛即刻缓解,术后第2天佩戴腰围下地活动,术后1周顺利出院。该患者资料图片见图3,4。"
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