- 原发性腰椎间隙感染的诊断和治疗
- 作者:蔡卫华|发布时间:2010-08-18|浏览量:1501次
摘要:目的 分析原发性腰椎间隙感染的诊断及治疗。方法 2004 年8 月~2008年12月收治10例原发性椎间隙感染病例,男6 例,女4 例,年龄26~79 岁,平均52 岁。腰部剧烈疼痛7例,轻度腰痛3例,均有发热,体温37.8℃~40.0℃,平均38.3℃。有糖尿病史4例,病前前列腺有创检查2例、尿路感染2例。血常规白细胞计数6例无明显增高,4例感染扩散后出现白细胞计数增高;血沉48~120mm/h,平均60mm/h;C-反应蛋白55~98mg/L,平均72mg/L;术前血液和尿液培养阳性各1例,分别为金黄色葡萄球菌和大肠埃希杆菌。CT和MRI检查显示,L2/3和L3/4 1例,L4/5 4例,L5/S1 5例,CT检查发现相邻椎体边缘不规则骨质破坏9例,MRT1相病变椎间盘呈不均匀低信号影,MRT2相为均匀的高信号影9例,椎管内脓肿1例。3例症状轻的年轻患者保守治疗6周后症状消失,7例保守治疗3~4周无效后行手术治疗,3例后路植骨内固定+前路病灶清除术,2例前路病灶清除术植骨+前路内固定,1例单纯前路病灶清除术,1例后路病灶清除植骨+后路内固定术,术后继续保守治疗5~7周,手术病例均行病理检查。结果 早期5例误诊(3 例结核,2 例肿瘤)。随访18 个月,平均8 ~ 24个月。3 例保守治疗后腰痛症状缓解,治疗8 周后ESR 和CRP 恢复正常,X 线和CT 检查提示病变节段无脊柱不稳,终板破坏处出现硬化。7例术后病理均提示感染,术后2 ~ 5天腰痛减轻,2 周左右消失,2 ~ 3周后体温、ESR 和CRP 恢复正常。除1例术后6月邻近节段复发外,其他均在术后5月恢复正常生活和工作,植骨病例均骨性融合,平均融合时间3.4月(3~5月),无内固定松动和断裂。结论 原发性腰椎间隙感染临床症状缺乏特异性,早期易误诊。对症状轻的年轻患者,可保守治疗。对保守治疗无效者,手术治疗可能是本病有效安全的治疗方法之一。江苏省人民医院脊柱外科蔡卫华
关键词: 腰椎;椎间隙感染;脊柱;内固定
Diagnosis and treatment of spontaneous infectious discitis of lumbar spine. //CAI Wei-hua, ZHANG ning, JIN Zheng-shuai, HU Zhi-yi ,LIU Yong-ming CAO Xiao-jian, YIN Guo-yong. Department of Orthopaedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029,China.
[Abstract ]Objective:To investigate the diagnosis and treatment of spontaneous infectious discitis of lumbar spine(SIDLS). Method:Clinical datas of ten cases of SIDLS treated from Aug 2004 to Dec 2008 were analysed. Male 6,female 4.Ages 26~79ys, mean 52ys.Seven cases had back severe spasm pain,3 cases had untypical back pain. All cases had fever range from 37.8℃ to 40.0℃ (average 38.3℃). History of past illness: diabetes mellitus 4 cases, invasive exam of prostate 2 cases, urinary tract infection 2 cases. Leucocyte number increased only in 4 cases after infection extension. Erythrocyte sedimentation rate ranged from 48mm/h to 120mm/h (average 60mm/h).C-reaction protein ranged from 55mg/L to 98mg/L (average 58mg/L). Two cases preoperative bacterial culture were positive in 2 cases ,one bacillus coli of blood, one staphylococcus aureus of urine. Involved level of CT and MRI: L2/3 combined L3/4 1 case,L4/5 4 cases,L5/S1 5 cases.CT exam displayed end plate irregular destruction of vicinity vertebras in 9 cases. MRI exam showed involved level uneven low signal changes in T1 phase, and well-distributed high signal changes in T2 phase in 9 cases, vertebral canal abscess in 1 case. Three young patients with slight pain were cured after conservative treatment for 6 weeks. Seven patients received operation after failed non-surgical treatment for 3 to 4 weeks, 3 cases anterior debridement with posterior instrumentation and bone graft, 2 cases anterior debridement and fusion with anterior instrumentation, 1case anterior debridement only because of old age, 1 case posterior debridement and interbody grafting with posterior instrumentation. Infection were certified by pathologic diagnosis in all cases. Conservative treatment was continued after operation for 5 to 7 weeks. Results Five patients were misdiagnosis at early stage(3 as tuberculosis, 2 as tumor). All cases were followed up from 8 to 24 months (average 18 months). Three conservative treated patients were cured after 8 weeks. Imageologic exam improved spine stabilization and end plate sclerosis of the initial erosion . Back pain , fever, ESR and CRP were relieved obviously of seven operated patients. Back pain disappeared within 2 weeks post-operation. Fever, ESR and CRP were normal from 2 to 3 weeks post-operation. All cases returned to normal life and work at 5 months post-operation, except 1 case recurred at vicinity vertebra after 6 months post-operation . All patients of bone graft obtained bone fusion within 5 months (average 3.4months). No implants loosening or breakage occurred. Conclusion Because of lacking specificity of its clinical manifestations, SIDLS is easy misdiagnosis on earlier period. Conservative treatment is effective for young patients without serious syndromes. Operation would be a effective and safe treatment in patients who had failed medical management.
【Key words】lumbar ; disc space infection ;spinal column; internal fixation
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