术后椎间盘炎的影像学表现及其介入治疗

Imaging Manifestation and Interventional Therapy of Postoperative Disctitis

目的：提高对术后椎间盘炎临床与影像学表现的认识，探讨其预防及介入治疗方案。材料与方法：对３２ 例患者椎间盘炎的病理、临床、影像学表现、预防及介入治疗方案进行分析。结果：病理学检查示间盘组织中有中性粒细胞和淋巴细胞浸润；影像学表现主要有椎间隙变窄，椎体局限性骨质破坏及终板增生与硬化；腰背部剧烈疼痛伴血沉加快是主要临床表现；主要病原菌为金黄色葡萄球菌、表皮葡萄球菌、大肠杆菌等。氯林可霉素、妥布霉素、先锋霉素Ｖ 静脉给药可渗入人体椎间盘内，手术前后用此类抗生素能阻止椎间盘炎的发生；ＰＬＤ 技术可缓解症状，缩短病程。结论：手术前后应用可进入椎间盘内的抗生素是预防该病的有效方法；充分认识该病的临床与影像学表现，有助于该病的早期诊断；ＰＬＤ 技术治疗该病效果好。

Purpose: To improve the recognization of the clinic and imaging finding of postoperative disctitis, to study the method on prevention and inerventional therapy of the disease. Materials and Methods: It was analysed that the pathologic, clinical, imaging finding, and preventional as well as theraputic plan of the disease in 32 cases. Results: The pathologic finding was that infiltrition of the neutrophil and lymphocyte in the intreverteberal disc. The main pathogens were Staphylococcus aureus, Staphylococcus epidermidis and Bacillus coli. The main features of imaging were persented as: narrowed intervertebral space, local destroy of vertebrae, erosion and sclerosis of bony end plates. Severe pain of lumbar back companied with rise of E.S.R. was the important sign of clinic. Clindamycin, tobramycin and cephazolin were the antibiotics which could penetrate into the nucleus pulposus via I.V. PLD could relief the symptoms and decrease the course of the disease. Conclution: It could prevent effectively the postoperative disctitis that above antibiotics were given preoperation and post operation. It is benifited to fully recognized the clinical and imaging features of disctitis for early diagnosing the disease. PLD is a useful therapentic method for postoperative dictitis.