腰椎间盘术后椎间盘炎的诊断与治疗

Diagnosis and Treatment of the Discitis Following Lumbar Discectomy

目的：介绍腰椎间盘术后椎间盘炎的临床特点，讨论治疗方法。方法：对１３例术后椎间盘炎临床资料回顾，分析常见诊治失误原因。依靠临床体征、血沉、Ｃ—反应蛋白、Ｘ线、ＣＴ或ＭＲＩ建立早期诊断。非手术治疗治愈１０例，手术治疗治愈３例。结果：术后１１例随访６～３６个月。９例恢复原工作，４例遗有慢性腰痛或腰椎活动受限，２例不能胜任体力劳动。结论：早期诊断应重视术后再发剧烈腰痛的特殊体征。血沉、Ｃ—反应蛋白是提示感染或观察疗效的指标。Ｘ线、ＣＴ、ＭＲＩ有诊断价值。多数患者经严格卧床，大剂量广谱抗生素治疗效果满意。保守无效，炎症扩散出现相应临床症状者，应行病灶清除术。

Objective:To discuss the main clinical findings and treatments of discitis following lumbar discectomy.Methods:Thirteen cases of discitis following lumbar discectomy were reviewed.The causes of misdiagnosis and incorrect treatment were analyzed.The early diagnosis was made according to the early clinical signs,ESR,C RP,radiography combined with CT scan and MRI.Ten cases were treated with antibiotic combined with bed rest.Three patients underwent surgical treatment.Results:Eleven patients were followed for six to thirty six months.The preoperative work could be finished in nine patients and could not be finished in two.Four cases still had chronic back pain and sight limitation of spinal motion.Conclusions:Postoperative back pain must be paid attention to and is a special clinical sign for early diagnosis.ESR and C RP are very useful in the diagnosis.MRI and radiography combined with CT scan play important roles in the differential diagnosis.Most of the patients can be cured with conservative treatment.Surgical decompression is indicated in cases of spread of the infection and compression of the spinal cord and nerve roots.