继发性腰椎间盘炎的诊断及治疗

Diagnosis and treatment of discitis after surgery for lumbar disc herniation

目的探讨腰椎间盘突出症术后继发性椎间盘炎的诊断与治疗.方法回顾性分析手术治疗腰椎间盘突出症890例的临床资料,对其中继发腰椎间盘炎17例(发生率1.91%)的临床症状、体温、白细胞总数、血沉、C反应蛋白以及治疗方法进行探讨.结果继发腰椎间盘炎发病时间最早在术后第6d(6例),在术后第10～12d症状明显的变化(11例).除1例需二次手术外,余16例均经保守治疗6～8周后治愈.随访12-36个月,16例恢复正常生活与工作.1例仍有腰背痛.结论根据腰间盘突出症术后疼痛缓解,一段时间后再次出现明显腰痛,血沉增快,C反应蛋白升高,可考虑继发性椎间盘炎诊断.治疗方法以保守治疗为主.

Objective To explore the diagnosis and treatment of discitis after surgery for lumbar disc herniation（LDH}. Methods The clinical materials of 17 patients with postoperative discitis among 890 cases underwent LDH from Jan 1988 to Jun 2004 were analysed. The clinical symptoms,changes of body temperature,total number of WBC, ESR, CRP,and therapeutic methods were explored. Results The date of onset of early discitis was in 6 days （6 cases） and severity in 10-12days （11 cases）. Sixteen cases were treated by antibiotics and strict bed rest for 6-8 weeks. One case was treated by resurgical method. Seventeen cases were followed-up for 12-36 months. Among them,the normal life and work were recovered in 16 cases,one case had chronic back pain. Conclusion Obvious low back pain after some time of LDH surgery,ESR increasing, and the level of CRP elevating are very useful to the diagnosis of postoperative discitis. Most of the patients can be cured by conservative therapy.