【摘要】 目的探讨化脓性脊椎炎的临床诊断与治疗方法。方法回顾性分析自2011-04—2015-07诊治的20例化脓性脊椎炎。14例行后路病灶清除后,椎间隙植入自体碎骨粒或部分同种异体骨,再行椎弓根钉内固定。6例前后联合入路者,先俯卧位行后路椎管内病灶清除减压椎弓根钉内固定,再行前路椎体及椎间隙病灶清除,取髂骨块植骨或自体骨粒填充cage行椎体间的支撑融合。结果 20例切口均一期愈合。术后患者局部疼痛均不同程度缓解,体温逐步恢复正常,术后复查实验室检查指标均下降至正常。20例中12例细菌培养的结果为阴性,8例为金黄色葡萄球菌。14例术前合并脊髓神经损伤者神经功能均得到不同程度恢复:1例C级恢复至D级,3例C级恢复至E级;6例D级均恢复至E级;10例E级均未有神经症状加重。本组术后随访10~36个月,平均20个月,均无复发。术后3个月复查X线片提示植骨节段均达到骨性融合标准,内固定物位置正常、可靠。结论化脓性脊椎炎的早期诊断依据病史、症状、体征、影像检查(特别是MRI)及穿刺活检,在炎症得到控制的前提下积极行病灶彻底清除、椎管内有累及者行减压、椎间植骨或cage置入并椎弓根钉内固定术,效果满意。更多还原

【Abstract】 Objective To investigate clinical diagnosis and treatment of pyogenic spondylitis. Methods Twenty patients with pyogenic spondylitis treated from April 2011 to July 2015 were retrospectively analyzed. Fourteen patients underwent posterior lesions removal, intervertebral implantation of autologous bone grain or part of allogeneic bone, and pedicle screw fixation. The combined anterior and posterior approaches were used in six patients, the posterior spinal canal lesions prone position lesions removal and decompression and pedicle screw internal fixation were performed, followed by anterior vertebral body and intervertebral lesions removal, iliac bone graft or autologous bone grain grafting to fill cage line for the integration between the vertebral bodies. Results Twenty cases achieved primary healing of incision. Postoperative local pains were relieved to different degrees, and the body temperature gradually returned to normal, the laboratory examination indexes recovered to normal. Twelve cases had the negative results of bacterial culture while 8 cases had staphylococcus aureus. The nerve function of 14 patients with preoperative combined spinal cord damage recovered to different degrees, 1 case recovered from C to D level, 3 cases from C to E level, 6 cases from D to E, the neurologic symptom was not worse in 10 cases of E level. The follow-up was 10-36 months, an average of 20 months, there was no recurrence. Postoperative 3 months X ray film showed bone graft section achieved bony fusion, the internal fixation position was normal and reliable. Conclusion The early diagnosis of pyogenic spondylitis is based on medical history, symptoms, signs, imaging(MRI) especially and biopsy. On the premise of inflammation under control, the lesions are thoroughly removed; the decompression is performed on involved vertebral canal, followed by intervertebral bone graft and pedicle screw or cage fixation. The effect is satisfactory.更多还原