| Background:Surgical treatment of patients with Pyogenic Vertebral Osteomyelitis(PVO),which mainly includes surgical debridement and reconstruction of the stability of the spine.At present,the generally accepted method to reconstruct spinal stability is bony fusion and posterior pedicle screw fixation.Autologous iliac bone strut,allograft,Polyetheretherketone(PEEK)cages,titanium mesh cage may be used as materials for bony fusion.However,there are few domestic studies to verify and compare the safety and effectiveness of these materials.Objective:To demonstrate the effectiveness and safety of the use of titanium mesh cage and autologous iliac bone strut in the surgical management of PVO,besides,compare the outcomes of patients treated using titanium mesh cage followed by posterior pedicle screw fixation for PVO,with the outcomes of patients treated using autologous iliac bone strut and posterior pedicle screw fixation.Methods:Patients who diagnosed with PVO and received surgical debridement,bony fusio,posterior pedicle screw fixation in the First Affiliated Hospital of Nanchang University from January 2014 to December 2019 were reviewed retrospectively to analyze the clinical results.Screening by the inclusion and exclusion criteria,the patients who met the criteria were included in the retrospective study.According to the bony fusion materials taken by the patients,they were divided into a group using only autologous iliac bone(group A)and a group using titanium meshcage(group B).The length of hospital stay,operation time,the intraoperative bleeding volume,bedrest duration,hospital charges(excluding the cost of internal fixation materials),bony fusion rate,subsidence rate,and postoperative infection recurrence rate;Erythrocyte sedimentation(ESR)and C-reactive protein(preoperative and postoperative 7 days,1 month,the last follow-up);the length of hospital stay,Cobb angles(preoperative,postoperative,the last follow-up),Frankel grade(preoperative,Postoperative 1 month,the last follow-up),Visual Analogue Score(VAS)(preoperative,postoperative 7 days,1 month,3months);Japanese Orthopaedic Association(JOA)assessments(preoperative,postoperative 1 month,3months,the last follow-up).Results:We enrolled a total of 426 patients who were diagnosed with PVO and received surgical treatment in the First Affiliated Hospital of Nanchang University.Finally,according to the inclusion and exclusion criteria,we screened a total of 77 patients for analysis.Among these 77 patients,49 patients used autogenous iliac bone strut were divided into group A,with an average age of 58.37±10.39 years old;titanium mesh was used for 28 Patients were divided into group B,with an average age of57.82±8.13 years old.The average follow-up time of the two groups was 25.62±13.73 months.1.The comparison of the general clinical situation of patients enrolled that before surgery.There was no statistical difference in gender,average age,the extent of vertebral body destruction and factors affecting recurrence risk in all patients between the group A and B(P>0.05).The lumbar spine was the most commonly affected segment(75.3%),followed by thoracic spine(19.5%),the affected segment did not show statistically significant difference between the group A and B(P>0.05).2.In the comparison of the operation and hospitalization of the two groups.The intraoperative bleeding volume of group A was 586.33±370.07(ml),the operation time was 223.57±103.68(min),and the length of hospital stay was 25.78±8.42(d),the hospital charges(excluding the cost of internal fixation materials)was56467.52±14995.93 yuan;the intraoperative blood loss of group B was755.36±431.91(ml),the operation time was 264.64±103.16(min),and the length of hospital stay was 28.5±11.09(d),the hospital charges was 62980.94±25057.71 yuan.There was no difference between the A and B groups in the intraoperative bleeding volume,operation time,the length of hospital stay,and hospital charges(excluding the cost of internal fixation materials)(P>0.05);The bedrest duration of group A was 8.94±2.59 days;and 7.68±2.51 days of group B,there was a statistical difference between tow groups(P<0.05).3.In the comparison of the postoperative clinical effects of the two groups.The preoperative VAS score of the A and B groups,the VAS score(postoperative 3months),the preoperative JOA score,the JOA score(postoperative 3months,the last follow-up)There was no significant difference in both group.The VAS score(postoperative 7days,1months)of patients in group A were 6.33±0.85 and 4.24±1.11;The VAS score(postoperative 7 days,1months)of patients in group B were 4.89±1.03,3.18±1.06 There exists a significant statistical difference between the two groups(P<0.05).4.In the comparison of postoperative infection control of the two groups.The ESR(preoperative,postoperative 7days,1 month,the last follow-up),there exists no significant statistical difference,as so as the C-RP.(P>0.05);For intragroup comparisons,the ESR and CRP values of the two groups at the first month after surgery and the last follow-up were significantly improved compared with those before the operation(P<0.05).At the last follow-up,the ESR and CRP values of the two groups of patients basically all returned to normal;A and B groups had no significant difference in postoperative infection recurrence rate(P>0.05).5.Comparing the postoperative imaging effects of the patients.It was found that there was no significant difference in the improvement of the Cobb angle between the A and B groups(P>0.05);The Cobb angle was significantly improved compared with that before operation(P<0.05);the difference between the last follow-up Cobb angle and the postoperative Cobb angle of A and B groups was 1.77±1.68° and0.9971±1.00°,respectively.The difference is statistically significant,(P<0.05).There was no significant difference in the rate of bone graft material settlement and bone graft bone fusion rate between the A and B groups(P>0.05).Conclusions:1.Autologous iliac bone and titanium mesh are both safe and effective in bone graft fusion surgery used in PVO,during thorough debridement,restoration of spine structural stability and effective antibiotic treatment.2.Compared with patients who use autologous iliac bone for fusion,patients who use titanium mesh cage for fusion have less surgical trauma,shorter postoperative bed time,higher postoperative functional recovery,and correction of segmental spine The convex effect is more reliable. |
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