腰椎间盘术后椎间隙感染

PostoperativeIntervertebralDiscitisoftheLumbarSpine

作者报告了近１５年收治的腰椎间隙感染１３例，其中３例曾误诊为腰椎结核和椎体肿瘤。１１例经保守治愈，２例手术治愈。病变间隙：Ｌ３４２例，Ｌ４５８例，Ｌ５Ｓ１３例。行同位素骨扫描６例，腰椎ＣＴ扫描８例，ＭＲＩ检查５例，腰椎Ｘ线断层５例，均有腰椎系列Ｘ线平片。作者认为：本病因以细菌感染可能性大，反应蛋白和血沉可作为预示感染和观察疗效的指标，ＭＲＩ、ＣＴ、ＥＣＴ、Ｘ线检查具有诊断价值，ＭＲＩ将本病与腰椎结核、椎体肿瘤及退变加以鉴别，多数患者经保守治疗可以治愈，对有神经受损症状、保守治疗无效、椎体破坏超过５０％者，应行病灶清除术或植骨融合，经皮髓核摘除术具有明确诊断和治疗作用。

Duringthelast15yearperiod,13casesofpostoperativediscitiswereencountered.Theageofthepatientsrangedfrom18to68withanaverageof45.5years.ThespinalsegmentinvolvedincludedL3 4intwo,L4 5ineightandL5 S1inthreecases.Onehadbeenmisdiagnosedastuberculosis,and2astumors.Elevenpatientsweretreatedwithantibioticcombinedwithbedrestandphysiotherapy.Twounderwentsurgicaltreat ment.Themostposibleetiologicalfactorsofthisconditionwasbacterialinfection.C-RPandESRareveryusefulinthediagnosis.RadiographycombinedwithCTscan,ECTandMRIplayimportantrolesinthedifer entialdiagnosiswithtumor,tuberculosisanddegenerativechangesofthelumbarintervertebralspace.Percuta neousdiscecotomyisveryusefulnotonlyforthediagnosisbutalsoforthetreatment.Mostofthepatientscanbecuredwithconservativemeasures.Whenhalfofthevertebralbodywasinvolvedorthereweresignsofcom presionofthenerveroots,surgicalinterventionanddecompressionwereindicated.