经皮腰椎间盘摘除术后椎间盘炎的诊断与治疗

Diagnose and therapy of the post-operation discitis after percutaneous lumbar diskectomy

目的探讨经皮腰椎间盘摘除术（percutaneous Lumbar diskectomy，PLD）术后椎间盘炎（Post operation discitis，POD）的临床表现及介入治疗方法。方法回顾分析13例PLD术后椎间盘炎患者的临床资料，影像学资料及治疗方法。10例采用一次PLD冲洗＋静脉内抗生素治疗，3例采用椎间盘内置管（同轴）引流术加静脉抗生素治疗。结果POD的发病时间多为2～7天，主要临床表现为：腰背部跳痛，红细胞沉降率（ESR）增快，平均为,18mm／h，C-反应蛋白（CRP）增高，平均52μg／ml；CT表现：早期为椎间隙密度减低，后期表现椎间隙狭窄及硬化征象。MRI表现为：T1WI椎间盘及邻近椎体信号强度减低，T2WI表现为高信号。椎间盘细菌培养10例为阳性，13例POD患者均临床治愈。榷间盘冲洗及置管引流可较快缓解腰背部疼痛和缩短住院时间7～12天。结论PLD术后出现剧烈腰背部疼痛应首先考虑POD的可能；CRP增高，ESR增快和MRI信号改变是早期诊断POD的重要指征，椎间盘冲洗可较快缓解临床症状和缩短病程。

Objective To discuss the clinical manifestation and interventional therapy methods of post operation discitis（POD） after percutaneous lumbar diskectomy （PLD）. Methods The clinical data, imaging data and therapy methods of 13 patients who suffered POD were analyzed retrospectively. 10 received one time rinse of the intervertebral disc and intravenous antibiotic therapy, and the other 3 received intervertebral tube drain and intravenous antibiotic therapy. Results The onset of POD mostly happened during the 2nd to 7th day after PLD. The main clinical manifestation is waist and back jumping pain. The erythrocyte sedimentation rate （ESR） increased to 48mm/h on average. The C-reactive protein level raised up to 52μg/L on average could show degradation of density at intervertebral space in the early stage of POD and stenosis as well as sclerosis signs in the later. MRI could show weaken of signal intensity at intervertebral disc and adjacent vertebral body in T1WI,and show enhancement in T2 WI. The results of bacterial culture were positive in 10 patients. All the 13 patients were clinically cured. Intervertebral disc rinse or tube drain could soon relieve the pain of waist and back; shorten length of stay about 7 to 12 days. Conclusions POD should firstly be considered possible if the patient appears severe pain of waist and back after PLD. The raise of CRP level, increase of ESR and changes of MRI signal are important indications for early diagnosis of POD. Intervertebral disc rinse could soon relieve clinical symptoms and shorten the course of disease.