原发性腰椎间隙感染的诊断和治疗

Diagnosis and treatment of primary lumbar discitis

中文关键词:  腰椎  椎间隙感染  诊断  治疗

英文关键词:Lumbar vertebra  Disc space infection  Diagnosis  Treatment

中文摘要:

  【摘要】 目的：探讨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例原发性腰椎间隙感染患者，男6例，女4例，年龄26~79岁，平均52岁。轻度腰痛3例，腰痛伴下肢放射痛2例，仅有腰部剧痛5例，体温37.8℃~41.0℃，平均38.3℃。有糖尿病史4例，发病前前列腺有创检查2例、尿路感染2例。血白细胞计数正常6例，增高4例；均有血沉（ESR）和C-反应蛋白（CRP）增高；术前血液和尿液细菌培养阳性各1例，分别为金黄色葡萄球菌和大肠埃希杆菌。病变节段L2/3和L3/4 1例，L4/5 5例，L5/S1 4例。CT检查发现相邻椎体边缘不规则骨质破坏9例（其中1例L5椎弓根破坏），MRI T1像示病变椎间盘呈不均匀低信号影、MRI T2像为均匀的高信号影9例，椎间盘信号异常伴椎管内占位1例。5例诊断为原发性腰椎间隙感染，予绝对卧床和抗生素治疗，其中3例年轻患者保守治疗有效而未行手术，2例保守治疗无效而行手术治疗；3例诊为结核，2例诊为肿瘤，均行手术；7例手术患者术后均行病理检查及抗生素治疗。结果：7例术后病理检查均提示感染。随访8~24个月，平均18个月。3例保守治疗1周后腰痛缓解，6周后ESR和CRP恢复正常，治愈后12 个月随访时腰椎X线片检查提示病变节段无脊柱不稳。7例手术治疗患者术后2~5d腰痛减轻，2周左右消失，2~3周后体温、ESR和CRP恢复正常；植骨均骨性融合，平均融合时间为3.4个月（3~5个月），无内固定松动和断裂。1例术后6个月邻近椎间隙出现感染，其余均在术后5个月恢复正常生活和工作。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。对年轻患者，可行保守治疗。对保守治疗效果不佳或症状较重者，手术治疗是安全有效的治疗方法。

英文摘要:

  【Abstract】 Objective：To investigate the diagnosis and treatment of primary Lumbar discitis（PLD）.Method：Clinical data of 10 PLD cases treated from Aug. 2004 to Dec. 2008 were reviewed retrospectively.There were 6 males and 4 females with the mean age of 52 years（range，26-79 years）.At admission，three cases had slight back pain，2 cases had back pain and severe leg pain，only 5 cases had severe back pain.All cases had fever range from 37.8℃ to 40.0℃（average 38.3℃）.Prior to discitis，4 cases had diabetes mellitus，2 had invasive exam of prostate，2 had urinary tract infection.Leucocyte count showed normal in 6 cases，increased in 4 cases.ESR and CRP increased in all cases.Preoperative bacterial cultures showed positive in 2 cases，one bacillus coli of blood and one staphylococcus aureus of urine.Involved level was L2/3 combined L3/4 in 1 case，L4/5 in 5 cases，L5/S1 in 4 cases.CT scan showed end plate irregular destruction of vicinity vertebrae in 9 cases（L5 pedical erosion in 1 case）.MRI exam showed involved level uneven low signal changes in T1 phase，and well-distributed high signal changes in T2 phase in 9 cases，abnormal signal of involved disc accompanied by vertebral canal tumor in 1 case.Five cases diagnosed as PLD were treated with bed rest absolutely and antibiotic administration，of these，3 young patients healed without operation after conservative treatment，2 cases underwent surgery due to irresponsibility to conservative treatment.While for the other 5 cases，3 were diagnosed as tuberculosis and 2 as tumor，received operation.Seven patients experiencing surgery had pathologic test and antibiotic treatment.Result：Pathologic etiology was infection in 7 cases undergoing surgery.All cases were followed up from 8 to 24 months（average，18 months）.Three patients receiving conservative treatment had back pain relieved after 1 week treatment，ESR and CRP returned to normal after 6 weeks.Lumbar X-ray showed no unstability at 12 month.In seven patients experiencing surgery，all had back pain relieved or even disappeared，ESR and CRP returned to normal at 2 to 5 days，2 weeks and 2 to 3 weeks post-operation respectively.All had complete bone union at 3 to 5 months follow-up（mean 3.4months） with no instrument failure noted.All cases returned to normal activity and began to work at 5 months，except for 1 case developing new pathological changes at adjacent vertebra after 6 months.Conclusion：PLD is easily misdiagnosed on its early stage due to lack of specificity on clinical symptoms.Conservative treatment is effective for young patients.Operation should be considered for patients irresponsible to conservative treatment or havng severe symptom.