关键词: 革兰氏阴性菌, 脊柱炎, 化脓, 外科手术, 治疗结果

Abstract:

Objective To explore the surgical curative effect of Gram-negative bacterial vertebral osteomyelitis (GNB VO).Methods Between Jan 2007 and Dec 2016, 13 GNB VO patients underwent surgery in Beijing Chest Hospital were analyzed in this study. All of the 13 cases had high risk factors or history of infection. The pathogenic bacteria include 9 cases of escherichia coli, 2 cases of klebsiella pneumoniae, 1 case of pseudomonas aeruginosa and 1 case of enterobacter cloacae. The changes of visual analogue scale score (VAS), WBC, neutrophile granulocyte, ESR, CRP before and after surgery were evaluated. Bone fusion at 12 months follow-up has also been observed. The paired samples t-test was performed to assess the differences,which were considered statistically significant at P<0.05.Results The VAS, WBC, neutrophile granulocyte, ESR, CRP ((1.46±0.78) score, (7.14±1.20)×10 ⁹/L, 0.69±0.03, (10.29±4.82) mm/1 h, (3.57±2.07) mg/L) at the final follow-up were significantly improved than that before surgery ((7.38±1.19) score, (15.93±2.82)×10 ⁹/L, 0.80±0.02, (72.71±18.45) mm/1 h, (53.20±18.25) mg/L) (t were 33.34, 8.99, 6.40, 9.21 and 6.67, respectively;Ps=0.000).Thirteen patients who received sensitive antibiotic combined surgery were cured after 12-16 weeks treatment. One case with klebsiella pneumoniae infection which turned into fistula at 2 weeks after surgery, was cured after 3 times vacuum sealing drainage dressing treatment. All cases had bone fused without recurrence at 12 months follow-up.Conclusion The cases of GNB VO could be cured by combination of sensitive antibiotic and surgery, and the duration of sensitive antibiotic is no less than 12-16 weeks.

Key words: Gram-negative bacterial, Spondylitis, Suppuration, Surgical procedures, operative, Treatment outcome