椎间隙感染的诊断及手术指征

Diagnosis and operation indications of intervertebral space infection

目的通过临床病例分析总结椎间隙感染的临床表现特点、诊断要点,探讨手术指征。方法12例确诊为椎间隙感染的病例,手术组9例,行前路病灶清除、椎间植骨融合术;非手术组3例,大剂量抗生素静脉用药,卧床>4周,外固定后康复出院。结果2组病例均临床痊愈出院,随访>6个月,无复发。结论椎间隙感染早期确诊后以大剂量青霉素类抗生素治疗和卧床为主,若短期内用药无效、体温和白细胞持续升高或者影像学显示相邻椎体终板有破坏应及时手术治疗;前路病灶清除术能迅速缓解疼痛、缩短病程。

Objective To summarize clinical features, diagnosis points and to explore operation indications of intervertebral infection by clinical cases. Methods Twelve patients had confirmed diagnosis of intervertebral infection, 9 of who underwent surgical treatment including anterior removal of infection focus and spinal fusion with bone autograft. Others were treated with large dosage of antibiotic combined with bed resting at least 4 weeks and underwent external fixation before discharge. Resuits Both operation group and non-operation group achieved excellent outcomes. All the patients fully recovered and discharged. There was no recurrence during the follow-up of at last 6 months. Conclusion When intervertebral infection occurs, early diagnosis and sufficient penicillins combined with bed resting should be undertaken firstly. Surgical decompression should promptly be taken if non-operative treatment is invalid in a short-term with rising temperature and white cell count, or destroyed endplate of vertebral body in radiographic images. Anterior removal of infection＇focus has the advantage of relieving pain rapidly and shortening the course of treatment.