儿童原发性椎间盘炎的临床特点与意义

The clinical characteristics and significance of children’s primary discitis

目的：探讨儿童原发性椎间盘炎的临床特点及诊治方法。方法研究对象为2008年7月至2011年7月我们收治的儿童原发性椎间盘炎患儿，观察治疗前后临床特点、实验室检查结果、X线平片、CT扫描及三维重建、核磁共振扫描结果、诊断与鉴别诊断依据，并进行比较分析。结果共收治3例原发性椎间盘炎患儿，1例以腰椎结核收入院。体温升高、血沉增快、椎间隙狭窄、CT扫描椎体不同程度的虫蚀样骨质破坏及MRI扫描临近锥体T1加权像呈对称性带状低信号，而T2加权像呈对称性带状高信号是本组病例的共同特征。MRI检查对诊断有重要价值，可作早期诊断，经严格卧床休息、支具固定及抗炎治疗，3例患儿临床症状消失，体温、血沉、C-反应蛋白均正常，MRI复查提示椎间盘及临近椎体异常强化信号消失。平均随访2．5年，无复发。结论早期明确诊断，早期治疗，能缩短病程，是治疗本病的关键。

Objetive To study the clinical characteristics and medical treatments of primary discitis. Methods Compare and analyze the children with primary discitis received in the hospital from July 2008 to Ju-ly 201 1 through observing the clinical features,the laboratory results,X-ray films,CT scanning ＆amp;three di-mensional reconstruction,MRI results as well as diagnosis before and after the medical treatments. Result-s Three cases of primary discitis were received and cured.Among the three cases,one child was received with spinal tuberculosis.The increasing temperature,rising erythrocyte sedimentation rate （ESR）,narrow interver-tebral disc space,various moth-eaten bone destruction on centrum by CT scanning,as well as MRI scanning near vertebral T1 weighted image showing symmetrical banded low signal while T2 weighted image showing sym-metrical banded high signal were the main features of these cases.The MRI checks played important roles in the early diagnosis.By resting in bed,external fixation brace and anti-inflammatory treatment,all the three children lost the clinical features,and the temperature,erythrocyte sedimentation rate （ESR）,and C-reactive protein all changed to normal level.The MRI recheck showed the missing of the enhanced signal in interverte-bral disc and the near vertebral.No cases relapsed during the 2.5 years of return visit. Conclusion Early clarified diagnosis and treatments which can shorten the courses of disease are the key points to the treatments of this disease.