脊柱化脓性骨髓炎的诊断及现代外科治疗

Diagnosis and modern surgical treatment of pyogenic osteomyelitis of the spine

[目的]探究脊柱化脓性骨髓炎的特点及外科治疗方法。[方法]39例脊柱化脓性骨髓炎患者均行一期前路病灶清除加椎间植骨术。分析其临床表现、实验室、病原学及影像学特点和疗效。[结果]随访2～17年，平均8．5年。所有患者腰背疼痛均有缓解，其中17例疼痛完全消失，其余22例有时轻微疼痛。下肢神经功能除1例感觉障碍加重，均有不同程度改善，临床症状和体征改善率20％～100％，平均75．6％。所有患者均获得骨性融合，融合时间2～6个月，平均4个月。血沉从术前平均73mm／h恢复到术后平均29mm／h，而C反应蛋白全部恢复正常。无与手术直接相关的死亡及其他并发症。病原学结果：19例（48．7％）患者细菌培养阳性：金黄色葡萄球菌阳性10例，表皮葡萄球菌2例，大肠杆菌2例，绿脓杆菌2例，肺炎链球菌1例，肺炎克雷白杆菌1例，弗氏柠檬酸杆菌1例。[结论]患者本身的基础疾患是导致脊柱化脓性骨髓炎发病的重要因素之一，不仅金黄色葡萄球菌可以致病。某些条件致病菌或非致病菌如大肠杆菌及表皮葡萄球菌等也可以导致脊柱化脓性骨髓炎的发病；C反应蛋白比ESR及白细胞计数更为敏感，可用于脊柱化脓性骨髓炎的诊断及判定疗效的重要参考指标；MRI对脊柱化脓性骨髓炎的诊断更为敏感、特异及准确；一期前路病灶清除植骨术是治疗脊柱化脓性骨髓炎安全有效的手术方法。

[Objective] To explore the characteristics and management of pyogenic osteomyelitis of the spine. [Method] Thirty-nine patients with pyogenic osteomyelitis of the spine, who were treated by single-stage anterior debridement and interbody bone graft fusion, were included. The clinical presentations, laboratory, biological as well as radiological characteristics and surgical outcomes were investigated. [Result] The mean follow-up duration was 8.5 years, ranging from 2 to 17 years. All the patients had marked improvement in their back pain, 17 of whom obtained complete recovery, the remaining 22 patients had occasional mild pain. Sensory deficit aggravated in 1 patient, the remaining 38 patients had marked improvement in the neurological function of the lower extremity. The recovery rate of clinical symptoms and signs ranged from 20% to 100% （averaged, 75.6%）. Bony fusion was obtained in all the patients in 4 months on average （ranged, 2～6 months）. ESR decreased from 73mm/h preoperatively to 29mm/h at 4 months after operation, while C reactive protein decreased to normal. There was no death and no other complication relating to opertion. Species of pathogen： culture positive in 19 cases （48.7%）. Of these, S. aureus in 10 cases, et al. [Conclusion] The underlying diseases of patients were risk factors of pyogenie osteomyelitis of the spine, pathogens involved not only S. aureus but also other low virulent organisms. CRP was more sensitive than ESR or white cell counts, it may also be the parameter to evaluate outcomes of therapy. MRI has been shown to have the highest sensitivity, specificity and accuracy in the diagnosis of pyogenie osteomyelitis of the spine. Single-stage anterior debridement and interbody bone graft fusion are save and effective to treat pyogenie osteomyelitis of the spine.