经皮病灶清除持续灌注冲洗治疗腰椎间隙感染

张西峰 王岩 王继芳 刘玉杰 梁雨田 刘郑生 张伯勋
                           北京解放军总医院骨科 北京市复兴路28号 100853北京301医院骨科张西峰
                           张爱莲 黄辉 范志伟 聂永康 杨立
                           北京市复兴路28号 北京解放军总医院放射科100853

【摘要】目的：探讨影像学引导下病灶清除持续灌注冲洗治疗腰椎间隙感染的疗效。方法：从1994年4月～2002年4月,收治椎间隙感染患者21例，L1-2 1例，L2-3 2例，L3-4 7例，L4-5 8例，L5S1 3例。其中15例在影像学引导下按照经皮椎间盘摘除术的入路进入病灶，清除和冲洗椎间隙坏死组织。应用McGill表定量动态评价患者疼痛的变化情况。定期复查X线、CT和MRI。结果：接受微创手术患者在术后1～2天剧烈腰痛消失，冲洗时间为7～50天。细菌培养阳性率为6例占40％。8～12周椎间隙基本融合。治疗后McGill分值在1～2天内即开始下降。结论：影像学引导下病灶清除持续灌注冲洗治疗原发性椎间隙感染，及时有效控制症状，促进椎间融合达到早日康复的目的。
关键词：椎间隙感染 微创手术 CT 灌注冲洗
中图分类号 R681.53 文献标识码 A  文章编号 1005－8478（2003）19、20－1327－03
第一作者简介：张西峰(1963-)，主治医师，医学博士，研究方向：脊柱外科，
Email:[e-mail]
Percutaneous lumbar discectomy and persistent local irrigation and conduction in the treatment of intervertebral infection//Zhang Xifeng, Wang Yan, Liu Zhengsheng, Liang Yutian, Xiao Songhua, Liu Yujie, Zhang Boxun. The General Hospital of PLA, Orthopedic Department, Beijing, China. 100853
Zhang Ailian, Huang Hui, Fan Zhiwei, Nie Yongkang, Yang Li. The General Hospital of PLA, Radiological Department, Beijing, China. 100853
Abstract Objective：To investigate the therapeutic effect of the persistent irrigation and conduction for intervertebral infection. Methods From 1994.4-2002.4, 21 patients (15 men, 6 women) of lumbar intervertebral infection were treat among them 15 received percutaneous persistent local irrigation and conduction. The disc levels involved were at L1-L2 (n=1), L2-L3 (n=2), L3-L4 (n=7), L4-L5 (n=8), and L5-S1 (n=3). Under CT or c-arm X ray, one tube was put into intervertebral space. Debridement and irrigation were performed. Then two-cavity tube was inserted into intervertebral space. After operation, saline solution with antibiotics was used to irrigate intervertebral space 24 hours a day. When irrigative solution was clear and culture showed negative, it was time to stop the irrigation and conduction. The McGill pain questionnaire was used to observe the changes of lumbago. Results: all of patients who received minimal invasive surgery lumbago were relief after 1-2 days. The irrigation and conduction lasted 7-50 days. In 6 cases, bacterial growth is obtained from infected intervertebral discs about 40%. The intervertebral space fused at 8-12 weeks. The scoring will begin to descend after operation 1 or 2 days. Conclusion: Persiste