术后椎间盘炎的诊断与治疗

Diagnosis and treatment of postoperative discitis

目的 研究术后椎间盘炎的诊断、治疗方法。方法 回顾分析 9例术后腰椎间盘炎的临床表现、实验室检查及影像学表现 ,比较单纯静脉抗感染治疗和早期PLD +静脉抗感染的疗效差异。结果 术后发病时间平均为 7.6± 5 .6天 ;主要临床表现为腰背部剧烈疼痛 ,血沉增快平均为 ( 5 8.6± 18.0 )mm/h ,C反应蛋白增高平均为 ( 68.2± 2 0 .3 ) μg/ml;影像学主要表现为椎间盘水肿 ,椎间隙变窄和邻近椎体破坏。 9例均临床治愈。PLD可迅速缓解腰背痛和缩短住院时间平均达 3 2天。结论 术后再发剧烈腰背痛应考虑椎间盘炎可能 ;C反应蛋白增高、血沉增快和MRI表现是早期诊断椎间盘炎的重要指征 ;

Objective To investigate the diagnostic and therapeutic methods for postoperative discitis. Methods Clinical characteristics, CRP, ESR and imaging findings were retrospectively analyzed in 9 patients who were clarified as postoperative discitis. Among the 9 patients, intravenous injection of antibiotics was administrate in 3 patients, while the therapy with intravenous injection of antibiotics combined with percutaneous lumbar discectomy (PLD) in 6 patients. Results Clinical symptoms of discitis occurred 7.6±5.6 days after operation. Severe lumbar back pain with increase of erythrocyte sedimentation rate (ESR, 58.6±18.0 mm/h ) and C-reactive protein (CRP, 68.2±20.3 μg/ml) were the major clinical characteristics of discitis. The main features of imaging included disc edema, narrowed intervertebral space and destroy of vertebral bodies around the disc. All 9 patients were clinically free of symptoms after treatment. PLD could quickly relieve the severe pain of lumbar back in 6 patients and shorten the time of hospitalization for 32 days compared to the conventional therapy in 3 patients. Conclusion Postoperative discitis should be considered in case of recurrence of severe pain of lumbar back. Increase of CRP, ESR, and MRI changes were the most important evidences in early diagnosis for discitis. PLD can quickly relieve the clinical symptoms and shorten the course of diseases.