腰椎原发性椎间盘炎的手术治疗

Surgical treatment of spontaneous infectious discitis of the lumbar spine

目的探讨原发性椎间盘炎的临床特点及外科手术治疗方法。方法分析13例经外科手术确诊的原发性椎间盘炎患者的发病原因、临床表现、影像学特点、细菌学培养结果及在大剂量抗生素治疗的同时前路病灶清除后路固定的临床疗效。结果 1例患者有肾结石病史;2例患者有糖尿病病史。剧烈痉挛性腰痛、腰部活动严重受限、持续性低热、血沉增快是本病的主要临床表现。MRI检查对诊断有重要价值,可作早期诊断,8例细菌学培养阳性,5例为阴性,本组患者均行前路病灶清除,植骨融合并后路内固定,剧烈腰痛明显缓解,不再需用止痛剂,13例均治愈。结论如诊断明确,短期保守治疗无效者,宜早期手术。前路病灶清除植骨后路固定能迅速缓解症状,缩短病程,是治疗本病最为有效的手段之一。

Objective To study the clinical characteristics and surgical treatment of spontaneous infectious discitis of the lumbar spine.Methods 12cases of spontaneous infectious discitis were analysed retrospectively.Their clinical courses,the imaging examination and the bacterial cuture were studied.A1l patients were treated with operation of anterior route disc debridement and iliac autograft with posterior route internal fixation combined with antibiotics.Rseults Prior to discitis,1 case had kidney stone and urinary tract infection,2 cases had diabetes mellitus.The severe spasmodic back pain,the limitation of back motion and the lasting low fever were main clinical courses of the spontaneous discitis.ESR was very useful in the diagnosis.MRI played important roles in the early diagnosis.8 cases were positive in the bacterial cuture and 5cases were negative.After the surgery of anterior route disc debridement and iliac autograft with posterior route internal fixation,the symptoms were relieved in a short time.Conclusion The surgery of the anterior route debridement and iliac autograft with posterior route internal fixation has more advantages over conservative treatment.It is one of the most effective methods of treatment of the spontaneous infectious discitis.