胸椎结核性与化脓性炎症的临床特点及疗效分析(附102例报告)

Clinical characteristics and outcomes of primary thoracic tuberculosis and pyogenic spondylitis(with analysis of 102 cases)

目的评价胸椎结核性与化脓性感染各自的临床特点及治疗效果,以资术前鉴别诊断及早期确立治疗方案。方法 2000年1月～2011年1月共收治胸椎感染性患者102例,男68例,女34例;平均年龄47.2岁。其中结核性脊柱炎85例,化脓性脊柱炎17例。回顾分析患者的一般资料、病变节段、Frankel分级、影像学特点、治疗方法、手术方式、手术时间、出血量、治疗效果、并发症和致病菌等临床资料,予以对比分析并随访总结。结果结核性与化脓性脊柱炎患者之间平均年龄、入院时血沉和性别比例的差异无统计学意义(P>0.05);但起病时程、合并慢性疾病比例、合并神经症状比例、单节段与双节段病灶患者所占比例、椎旁脓肿比例以及术前发热比例的差异均有统计学意义(P<0.05)。经平均6.9个月随访,除2例结核患者行二次手术外,其余患者疗效良好。有神经症状的患者术后Frankel分级均有改善。结论胸椎结核性与化脓性感染有各自的临床特点,术前可予以鉴别,以免延误治疗。依据细菌药敏试验应用抗生素是治疗的原则。在非手术治疗无效的情况下对具备手术指征的患者,尤其是存在神经损害的患者需要开展早期手术治疗,术后疗效确切,预后良好。

Objective To investigate clinical characteristics and outcomes of primary thoracic tuberculosis and pyogenic spondylitis.Methods From January 2001 to January 2011,102 patients with thoracic infectious diseases were involved in this study.There were 68 males and 34 females with an average age of 47.2 years.Of them,85 patients suffered from tuberculosis spondylitis and 17 patients with pyogenic spondylitis.Clinical data,injured vertebral body,Frankel classification,radiological features,choice of treatment,surgical approach,operation time,blood loss,clinical outcomes,complications and pathogenic bacteria were retrospectively analyzed.Results Among the patients with tuberculous spondylitis and pyogenic spondylitis,there was no significant difference in terms of patient age and gender,and preoperative erythrocyte sedimentation rate（P〉0.05）;however,there were significant differences in terms of onset time,range of lesion,and the incidence of chronic disease,neurologic symptoms,paravertebral abscess and preoperative fever（P〈0.05）.The patients were followed up for 6.9 months on average,clinical outcomes were satisfied and only 2 patients received secondary surgery.Frankel classification was improved in the patients with nervous symptoms.Conclusion There is distinguished difference of clinical feature between thoracic tuberculosis and pyogenic spondylitis.To avoid delaying treatment,differential diagnosis of the diseases is necessary before surgery.Antimicrobial therapy according to susceptibility test is the treatment principle of spinal infectious diseases.Once conservative treatment is invalid,it is essential to perform operation to those with surgical indications,especially with neurological defects.Early-stage surgical treatment can achieve good clinical outcomes and prognosis.