非特异性脊柱感染的诊断与治疗

Diagnosis and treatment of non-specific spinal infection

中文关键词:  脊柱感染  非特异性  诊断  治疗

英文关键词:Spinal infection  Non-specificity  Diagnosis  Treatment

中文摘要:

  【摘要】 目的：探讨非特异性脊柱感染的临床特征及治疗方法。方法：回顾性分析我科2006年9月~2012年2月收治的16例非特异性脊柱感染患者的临床资料，男6例，女10例，年龄23～66岁，平均53.5岁。腰椎8例，胸腰段6例，胸椎2例。患椎处剧痛14例，轻度胀痛2例，11例X线片显示患椎终板缘“鸟嘴样”增生，13例邻近终板侵蚀性破坏，边界模糊，周围硬化。所有患者均无成角畸形及明显神经损害。入院诊断为脊柱肿瘤1例，脊柱结核3例，疑似脊柱结核8例，脊柱感染4例。入院后诊断为“脊柱肿瘤”者直接行“肿瘤椎体”切除植骨内固定术，术后病理诊断为化脓性脊柱骨髓炎；其余15例患者治疗前均行病椎穿刺病理检查，诊断为非特异性脊柱感染，其中10例患者行保守治疗，4例患者因椎间失稳行前路病灶清除植骨、后路内固定术，1例因伴椎旁脓肿行单纯前路病灶清除植骨融合术。均应用敏感或广谱抗生素，手术治疗患者应用2～3周，保守治疗患者应用3～6周。结果：所有患者随访3～18个月，平均12个月。10例保守治疗患者中，6例痊愈；4例遗留腰背部僵硬感，行腰背肌理疗及功能锻炼后均缓解。6例手术患者中，1例误诊为脊柱肿瘤患者术后1.5年X线片显示植骨端骨吸收，患者有腰背部僵硬感，暂予观察；其余5例患者随访时植骨均骨性融合，2例遗留不同程度腰背部僵硬，但均不影响生活。所有患者随访期间无复发。结论：脊柱非特异性感染容易误诊，治疗前行穿刺病理检查可早期确诊，多数患者经保守治疗可治愈，对影响脊柱稳定性者应选择手术治疗。

英文摘要:

  【Abstract】 Objectives: To study the clinic feature and the treatment of non-specific spinal infection. Methods: Retrospective analysis on 16 non-specific spinal infection patients aged from 23 to 66 years(mean, 53.5 years) from September 2006 to Febuary 2012 was carried out. There were 6 males and 10 females. The defect site was noted in lumbar spine of 8 cases, thoracolumbar spine of 6 cases, thoracic spine of 2 cases. 14 cases presented severe local pain, while 2 cases presented with slight pain; bird-mouth like osteophyte in peripheral endplate was noted in 11 cases, while breakage and sclerosis in adjacent endplate was noted in 13 cases. No kyphosis and remarkable neurological deficit was noted in cases. Admission diagnosis was spinal tumors in 1 case, spinal tuberculosis in 3, suspected spinal tuberculosis in 8 and spinal infection in 4. 1 case with doubted spinal tumor underwent corpectomy and stability reconstruction, while the postoperative pathological diagnosis was purulent spinal osteitis. The other cases suspected as non-specific spinal infection underwent vertebral needle biopsy, 10 patients received conservative treatment, while 4 patients suffering from instability received one-stage anterior debridement and posterior fixation, and 1 patient received simple anterior debridement and fusion for paraspinal abscess. All patients received broad-spectrum antibiotics, 2-3 weeks for surgery patients and 3-6 weeks for conservative patients. Results: All patients were followed up for 3-18 months(average, 12 months), 6 of 10 cases receiving conservative treatment healed completely, and the other 4 patients suffered from low back stiffness, which resolved after physical therapy and functional exercise. Among 6 surgical cases, 1 patient misdiagnosed as spinal tumors showed bony graft resorption in X-ray and presented with low back stiffness 1.5 years later, while the other 5 cases all showed bony union with no recurrence at final follow-up, 2 of them presented with some degrees of low back stiffness. Conclusions: Non-specific spinal infection is easily misdiagnosed. Needle biopsy may prove early diagnosis. The conservative treatment is optional for majority of patients, while surgery is considered when stability is injured.