医源性腰椎化脓性脊柱炎的手术治疗

Posterior debridement for the treatment of iatrogenic purulent lumbar spinal infection

目的:探讨医源性腰椎化脓性脊柱炎的诊断和治疗。方法:自2006年12月到2010年1月,采用病灶清除置管冲洗引流等综合治疗医源性腰椎化脓性脊柱炎患者4例,男2例,女2例;年龄50～66岁(年龄分别为:52、66、58、50岁);病程2周～2.5个月(分别为:21,14,60,75d)。所有患者术前均有发热史、腰痛、局部压痛和腰椎活动受限。白细胞计数(WBC)、血沉(ESR)均异常。术后通过临床症状的消失和监测WBC、ESR、C-反应蛋白(CRP)来评定疗效。结果:4例患者治疗后腰痛及发热症状消失,伤口均Ⅰ期愈合,无并发症发生,术后随访3个月无感染(WBC、CRP、ESR均正常)及腰椎不稳的情况发生。结论:医源性腰椎化脓性脊柱炎根据病史、症状、体征和影像学表现可以诊断。在诊断中磁共振表现有一定特异性,如有脓肿形成,应及早手术治疗。

Objective：To discuss diagnosis and treatment of iatrogenic purulent lumbar spinal infection.Methods：From December 2006 to January 2010,4 patients with iatrogenic purulent lumbar spinal infection were treated with posterior debridement.There were 2 males and 2 females,ranging in age from 50 to 66 years（respectively in 52,66,58,50 years）;in course of disease from 2 weeks to 2.5 months（respectively in 21,14,60,75 days）.All patients had fever,lumbago,local tenderness and limited lumbar activity before operation.White blood cell count（WBC）,erythrocyte sedimentation rate（ESR） were abnormal.The clinical effects were evaluated by symptoms and laboratory examination.Results：Symptoms of lumbago and fever vanished in 4 patients,of which wounds were primary healing without complications.The patients were followed up for 3 months,no infection（WBC,C-reactive protein and ESR were normal） and lumbar instability were found.Conclusion：Iatrogenic purulent lumbar spinal infection can be diagnosed according to course of disease,clinical symptoms and signs,imaging finding.In the items,magnetic resonance imaging finding have necessarily specificity,once finding abscess-formation,will promptly operate.