目的:脊柱盘炎危重患者的外科手术具有挑战性,存在一些争议。这里,我们介绍了在重症脓毒症伴脊柱椎间盘炎患者中早期提供手术干预的经验。
方法:在我们引入了一种提供早期但有限手术的新治疗模式之后,8例脊椎盘炎并发严重脓毒症和多器官功能衰竭的患者接受了为期10年的紧急手术治疗。在12个月随访和最后一次随访(平均89个月)时,根据Barthel指数评估结果。
结果:有7名男性和1名女性,平均年龄62岁.2例患者术前ASA评分为5分,6例患者中有4例。其中六个人出现了严重的麻痹,在所有这些中,脊柱椎间盘炎合并椎管内和/或椎旁脓肿在MR成像研究中很明显。所有患者均接受早期手术(入院后24h内)。重症监护的中位时间为21天。八个病人中,七个幸存下来。手术一年后,5例患者预后良好(Barthel指数:100(1);80(3);70(1)).在最后一次随访(平均89个月),4例患者具有良好的功能预后(Barthel指数在60和80之间)。
结论:对于患有脊椎盘炎和脓毒症的危重患者,早期手术治疗可能导致感染的快速控制,并可提供良好的长期预后。仅进行有限手术的一般策略对于具有相对较高手术风险的此类患者是有效的选择。
OBJECTIVE: Surgical procedures in critically ill patients with spondylodiscitis are challenging and there are several controversies. Here, we present our experience with offering surgical intervention early in critically ill septic patients with spondylodiscitis.
METHODS: After we introduced a new treatment paradigm offering early but limited surgery, eight patients with spondylodiscitis complicated by severe sepsis and multiple organ failure underwent urgent surgical treatment over a 10-year period. Outcome was assessed according to the Barthel index at 12-month follow-up and at the last available follow-up (mean 89 months).
RESULTS: There were 7 men and 1 woman, with a mean age of 62 years. The preoperative ASA score was 5 in 2 patients, and 4 in 6 patients. Six of them presented with high-grade paresis, and in all of them, spondylodiscitis with intraspinal and/or paravertebral abscesses was evident in MR imaging studies. All patients underwent early surgery (within 24 h after admission). The median time in intensive care was 21 days. Out of the eight patients, seven survived. One year after surgery, five patients had a good outcome (Barthel index: 100 (1); 80 (3); and 70 (1)). At the last follow-up (mean 89 months), 4 patients had a good functional outcome (Barthel index between 60 and 80).
CONCLUSIONS: Early surgical treatment in critically ill patients with spondylodiscitis and sepsis may result in rapid control of infection and can provide favorable long-term outcome. A general strategy of performing only limited surgery is a valid option in such patients who have a relatively high risk for surgery.