成人原发性椎间盘炎（8例报告与文献复习）

Primary Intervertebral Discitis in Adults-A Report of 8 Cases and Literature Review

本文报告了成人原发性椎间盘炎８例，其中男５例，女３例，年龄平均４４．５岁。病变间隙：Ｌ１～２１例，Ｌ２～３４例，Ｌ３～Ｌ４３例。入院前误诊为腰椎结核２例，椎体肿瘤３例。病因有三大学说即：细菌感染、无菌性炎症和自身免疫性反应，多数倾向于血源性细菌感染。讨论了临床特点、诊断与鉴别诊断及治疗问题。作者认为ＣＲＰ和ＥＳＲ较体温血象更敏感、更准确，可作为观察疗效的有效指标。本病应与腰椎结核、椎体肿瘤及退行性改变加以鉴别，ＭＲＩ有助于本病的诊断。保守治疗以卧床、大剂量广谱抗菌素治疗为主。经皮椎间盘镜行病灶清除及活检术有助于诊断和治疗。对椎体破坏超过５０％有神经受损症状、保守治疗无效者，手术病灶清除术同时可植骨融合，以增加脊柱稳定性。

During a 10-year-period,8 cases primary intervertebral discitis were treated.Among them,5 were men and 3 were women,the age ranged from 34 to 71.The involved vertebral were:L1-2in 1 case,L2-3 in 4 and L3-4 in 3.Of the 8 cases,5 were misdiagnosed as tuberculosis(2 cases)and tumour(3 cases).All the patients were treated with antibiotic combined with bed rest and physiotherapy and percutaneous discectomy were performed in 2 cases.Follow-up revealed the result is satisfactory.Percutaneous discectomy is very useful not only in diagnosis but also in treatment as well.If half of the vertebral body was involved or there were any signs of nerve compression,debridement and decompression or bone graft were necessary.