本文關(guān)鍵詞：一期前路病灶清除植骨內(nèi)固定術(shù)治療頸椎間隙感染的臨床研究　出處：《新疆醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 頸椎 椎間隙感染 植骨 內(nèi)固定器

【摘要】：目的:探討一期前路病灶清除植骨內(nèi)固定術(shù)治療頸椎間隙感染的臨床療效。方法:回顧性分析2010年6月至2014年6月我院行一期前路病灶清除植骨合內(nèi)固定術(shù)治療且獲得完整隨訪(fǎng)的68例頸椎間隙感染患者的資料,男42例,女26例;年齡17~79歲,平均53.6歲。單間隙感染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)、相鄰雙間隙感染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)。術(shù)后依據(jù)診斷給予抗炎治療,監(jiān)測(cè)紅細(xì)胞沉降率(erythrocyte sedimentation rate,ERS)及C-反應(yīng)蛋白(C-reactive protein,CRP)評(píng)估感染控制情況。采用Eck融合和分級(jí)標(biāo)準(zhǔn)[10]評(píng)價(jià)植骨融合情況,臨床療效評(píng)價(jià)采用視覺(jué)模擬評(píng)分(visual analogue scale,VAS)、日本骨科協(xié)會(huì)(Japanese Orthopaedic Association Scores,JOA)評(píng)分(頸椎)。結(jié)果:68例患者均順利完成手術(shù),手術(shù)時(shí)間60-90min,平均70min;術(shù)中出血量30-150ml,平均88ml,診斷化膿性頸椎間隙感染14例,結(jié)核性頸椎間隙感染39例,布氏桿菌頸椎間隙感染8例,不明原因頸椎間隙感染7例。術(shù)后隨訪(fǎng)時(shí)間13~32個(gè)月,平均15.7個(gè)月。術(shù)后患者臨床癥狀均明顯緩解。頸部VAS評(píng)分術(shù)前平均5.3±2.7分,術(shù)后1月為2.3±2.5分,術(shù)后6月為0.9±1.6,末次隨訪(fǎng)為1.0±1.3分,術(shù)后頸部VAS評(píng)分較術(shù)前明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)前JOA評(píng)分平均10.8±3.5分,術(shù)后1月為13.4±4.7分,術(shù)后6月為15.6±3.6分,末次隨訪(fǎng)為15.9±2.5分;JOA改善率為78.4%。所有患者在隨訪(fǎng)期無(wú)內(nèi)固定松動(dòng)現(xiàn)象。術(shù)后有7例患者出現(xiàn)聲嘶,給與甲鈷胺片口服,隨訪(fǎng)觀(guān)察一月后痊愈。2例患者術(shù)后2周內(nèi)出現(xiàn)切口感染,經(jīng)再次清創(chuàng)后痊愈。結(jié)論:一期前路病灶清除植骨內(nèi)固定術(shù)治療頸椎間隙感染可徹底清除病灶、解除神經(jīng)壓迫并提供堅(jiān)強(qiáng)內(nèi)固定,術(shù)后病理診斷及細(xì)菌培養(yǎng)可提供針對(duì)性的抗炎治療,療效確切,是一種良好的治療方法。
[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 鹵2.7 before operation. The scores of postoperative VAS were 2.3 鹵2.5 on January, 0.9 鹵1.6 on June, and 1.0 鹵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 鹵3.5,13.4 鹵4.7 in January and 15.6 鹵3.6 in June. The last follow-up was 15.9 鹵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.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

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