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目的 观察一期清创减压自体髂骨植骨融合内固定联合动态抗生素治疗原发性化脓性脊柱感染的临床疗效。方法 回顾性分析自2019-01—2024-06一期手术治疗的25例原发性化脓性脊柱感染，省略术前活体组织检查与细菌培养、术前48 h停用抗生素、一期清创减压自体髂骨植骨融合内固定联合动态抗生素治疗，术后48 h内应用第三代头孢（头孢哌酮舒巴坦钠）+左氧氟沙星，48 h后若细菌培养阳性则根据药敏试验结果选择敏感抗生素，细菌培养阴性则继续原方案。每周复查红细胞沉降率、C-反应蛋白，若炎症指标呈下降趋势，维持原方案；若连续2周指标下降不足50%或持续升高，考虑升级抗生素，重新评估是否存在其他感染。静脉应用抗生素3～6周，当患者临床症状改善、C-反应蛋白水平持续下降并接近正常时改为口服抗生素，总疗程为3个月。结果 25例均获得至少1年随访，未出现神经损伤、肺部感染、下肢深静脉血栓形成、内固定松动、感染复发等并发症。术后1个月时C-反应蛋白、白细胞计数恢复至正常范围，术后3个月时红细胞沉降率恢复至正常范围。术后9个月24例BridwellⅠ级骨性融合，1例BridwellⅡ级骨性融合。术后3个月疼痛VAS评分为2(2,2)分，生活质量SF-36评分为67(65,69)分；术后12个月疼痛VAS评分为0(0,1)分，生活质量SF-36评分为85(83.5,86)分。末次随访时采用MacNab标准评定疗效：优23例，良1例，可1例。结论 在严格掌握手术适应证的前提下，一期清创减压自体髂骨植骨融合内固定联合动态抗生素治疗原发性化脓性脊柱感染是安全有效的，可以有效控制感染，改善患者临床症状与脊柱功能，实现可靠的脊柱融合。
Abstract：Objective To evaluate the clinical efficacy of one-stage debridement, decompression, autogenous iliac bone graft fusion and internal fixation combined with dynamic antibiotic therapy for primary pyogenic spondylodiscitis.Methods A retrospective analysis was conducted on 25 patients with primary pyogenic spondylodiscitis who underwent one-stage surgery from January 2019 to June 2024. Preoperative biopsy and bacterial culture were omitted, and antibiotics were discontinued 48 hours before surgery. All patients underwent one-stage debridement, decompression, autogenous iliac bone graft fusion and internal fixation combined with dynamic antibiotic therapy. Within 48 hours postoperatively, a combination of a third-generation cephalosporin(cefoperazone-sulbactam) and levofloxacin was administered. After 48 hours, if bacterial culture was positive, sensitive antibiotics were selected based on drug susceptibility test results; if the culture was negative, the initial regimen was continued.Erythrocyte sedimentation rate and C-reactive protein were reviewed weekly. If inflammatory markers showed a downward trend, the regimen was maintained. If the markers decreased by less than 50% or continuously increased over two consecutive weeks, an antibiotic upgrade was considered and other potential infections were re-evaluated. Intravenous antibiotics were administered for 3 to 6 weeks. When clinical symptoms improved and C-reactive protein levels showed a sustained decrease approaching normal, antibiotics were switched to oral administration, for a total course of 3 months.Results All 25 patients were followed up for at least 1 year, with no complications such as neurological injury, pulmonary infection, lower extremity deep vein thrombosis, internal fixation loosening, or infection recurrence. C-reactive protein and white blood cell count returned to normal range 1 month postoperatively, and erythrocyte sedimentation rate returned to normal range 3 months postoperatively. Bridwell grade Ⅰ fusion was achieved in 24 patients and grade Ⅱ in 1 patient at 9 months postoperatively. At 3 months postoperatively,median(IQR) VAS score was 2(2,2) and SF-36 was 67(65,69); at 12 months postoperatively, VAS was 0(0,1) and SF-36 was85(83.5,86). Final follow-up MacNab outcomes were excellent(n=23), good(n=1), and fair(n=1).Conclusion Under strict surgical indications, one-stage debridement, decompression, autogenous iliac bone graft fusion and internal fixation combined with dynamic antibiotic therapy is safe and effective for primary pyogenic spondylodiscitis. This approach can effectively control the infection, improve clinical symptoms and spinal function, and achieve reliable spinal fusion.
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中图分类号:R687.3
引用信息:
[1]刘俊燕,周俊龙,邹亚琪,等.一期清创减压植骨融合内固定联合动态抗生素治疗原发性化脓性脊柱感染疗效分析[J].中国骨与关节损伤杂志,2026,41(03):230-234.
2026-03-15
2026-03-15