椎间隙改良穿刺抽吸活检对腰椎化脓性椎间盘炎的诊断价值

The value of modified puncture and aspiration biopsy in diagnosis of purulent discitis

目的：探讨椎间隙改良穿刺抽吸活检法对腰椎化脓性椎间盘炎的诊断价值。方法：2003年9月-2011年10月西安交通大学医学院附属红会医院收治腰椎化脓性椎间盘炎患者97例,男48例,女49例,年龄17-87岁,平均61.7岁。病变节段：L1/2 7例,L2/3 14例,L4/5 33例,L5/S1 43例。均行血细菌培养检查。均在CT引导下对病变部位进行经皮椎间隙穿刺抽吸活检,根据穿刺方法将患者分为3组,A组用传统穿刺方法（即方法A）,于病变椎间隙经CT定位皮肤穿刺针进针点位置,置入21G穿刺针抽吸标本;B组,如果方法 A未抽出液体,则注入生理盐水,再回抽液体（即方法 B）;C组,如果方法 B未抽出液体,则在病变椎间隙对侧经CT定位皮肤穿刺针进针点位置,置入另一根21G穿刺针进入椎间隙,从第一根针注入生理盐水,再用对侧的穿刺针回抽液体（即方法 C）,方法 B、C称为改良穿刺抽吸活检法。穿刺标本均行细菌培养检查。改良穿刺抽吸活检取得标本的成功率与传统穿刺法取得标本的成功率的比较采用T检验。血细菌培养阳性率与穿刺标本细菌培养阳性率的比较采用卡方检验。结果：97例患者均取得了标本,其中A组41例,B组36例,C组20例。97例患者采用方法 A穿刺活检,仅41例取得标本;对采用方法 A未能取得标本的56例患者采用方法 B或C穿刺活检均能取得标本。方法 B＋C取得标本的成功率与方法 A比较差异有显著性（P〈0.05）。97例穿刺标本中,93例细菌培养阳性（阳性率95.8%）,其中金黄色葡萄球菌47例（50.5%）,链球菌/肠球菌17例（18.28%）,大肠杆菌13例（13.98%）,假单胞菌10例（10.75%）,其他6例（6.45%）。97例行血细菌培养,其中47例（48.5%）阳性,金黄色葡萄球菌27例（57.44%）,链球菌/肠球菌9例（19.15%）,大肠杆菌6例（14.77%）,假单胞菌4例（8.51%）,其他1例（2.13%）。穿刺活检标本细菌培养阳性率与血细菌培养阳性率比较差异有显著性（P〈0.05）。血细菌培养阳性的47例患者,穿刺活检标本细菌培养均阳性,且培养出的细菌与血培养细菌一致。结论：椎间隙改良穿刺抽吸活检能提高腰椎化脓性椎间盘炎的病原学诊断率,其方法简单,取得标本的成功率高。

Objectives： To discuss the value of modified puncture and aspiration biopsy in the diagnosis of purulent discitis. Methods： From September 2003 to October 2011 in Hong Hui Hospital, Xi′an Jiaotong University College of Medicine, 97 cases with suspected lumbar purulent discitis were reviewed retrospectively.There were 48 males and 49 females, with the age ranging from 17 to 87 years, with an average age of 61.7years. The involved segments included： L1/2 in 7 cases, L2/3 in 14 cases, L4/5 in 33 cases, and L5/S1 in43 cases. CT-guided biopsy puncture and aspiration was performed. According to the puncture method, all patients were divided into 3 groups. Traditional methods were used in group A（method A）. On the target disc space, skin puncture needle point was located through CT-guide. and 21 G needle aspirate was performed. In Group B, only normal saline was given if method A failed（method B）. In Group C, if method B was failure,another 21 G puncture needle was punctured into the other side, and one for injecting normal saline, and the other side for withdrawing liquid（method C）. Method B and C were defined as modified puncture aspiration biopsy. Bacteria culturing of specimens was performed. Statistical method was used to test the result. Results：Biopsy specimens were taken from all patients： 41 cases in group A, 36 cases in group B, and 20 cases in group C. 97 patients underwent needle biopsy, however only 41 cases obtained specimens, which showed significant difference between method B ＋C and method A（P 0.05）. In 97 cases, 93 cases had positive bacterial culturing（95.8%）, among them, the pathogenisis included Staphylococcus aureus（50.5%, 47）,streptococcus and Enterococcus 18.28%（17 cases）, Escherichia coli 13.98%（13 cases）, Pseudomonas 10.75%（10）, the others 6.45%（6）. 97 cases had routine blood culturing, of 47（48.5%） positive pathogenisis, there were Staphylococcus aureus（57.44% and 27）, Streptococcus and Enterococcus 19.15%（9 cases）, Escherichia coli14.77%（6 cases）, Pseudomonas 8.51%（4 cases）, and other 2.13%（1 case）. Positive bacterial culturing rate was significantly different compared with the rate of positive blood culturing（P〈0.05）. In 47 cases of patients with positive blood culturing, all showed positive bacterial culturing, which were consistent with the blood culturing.Conclusions： The modified method may improve the diagnostic rate of purulent discitis in lumbar vertebra,which is of simple and high rate of puncturing.