老年脊柱术后急性感染诊断及治疗

Diagnosis and treatment of elderly patients with acute spinal postoperative infection

目的:探讨老年脊柱术后急性感染诊断及治疗。方法:回顾性分析了50例经手术病理证实的老年脊柱术后急性感染患者的临床及MRI资料,对椎体、椎间盘改变、椎旁脓肿及椎管内硬膜外脓肿的MRI表现进行分析。将高负压封闭引流术(high vacuum sealing drainage,VSD)应用于本组患者的临床治疗之中,对该方法的临床疗效进行评价。结果:1经病理诊断结果为化脓性脊椎炎、化脓性椎间盘炎以及继发硬模外脓肿分别为15例、14例及21例;经MRI诊断,化脓性脊椎炎、化脓性椎间盘炎以及继发硬模外脓肿分别为14例、12例及19例,与病理诊断符合率为90.00%。2经VSD术治疗后,优、良、中、差例数分别为22例、25例、3例、0例,治疗优良率为94.00%;非感染组(n=120)患者治疗后,优、良、中、差例数分别为56例、58例、6例及0例,治疗优良率为95.00%。3VSD术治疗前掌倾角与尺偏角分别为(4.23±0.72)°与(10.22±1.34)°,治疗后掌倾角与尺偏角分别为(5.78±1.32)°与(13.13±2.11)°,治疗前后掌倾角与尺偏角相比,差异均具有统计学意义(P<0.05)。结论:MRI对老年脊柱术后急性感染具有较高的诊断价值;VSD术治疗老年脊柱术后急性感染的效果较佳,值得在临床上加以推广并应用。

Objective：To investigate the elderly postoperative spinal diagnosis and treatment of acute infection. Methods：The clinical and MRI data of 50 cases of elderly patients with acute infection were retrospectively analyzed by pathologically confirming spinal sur-gery. The vertebrae,intervertebral discs change,paraspinal abscess and spinal epidural abscess MRI findings were analyzed. Then the high-vacuum sealing drainage （ VSD） was applied to the clinical treatment of this group of patients,and the clinical efficacy was evalua-ted. Results：① Results of pathological diagnosis：pyogenic spondylitis,pyogenic discitis and abscess secondary to hard outside were 15 cases,14 cases and 21 cases;diagnosed by MRI,pyogenic spondylitis,purulent disc inflammation and abscess secondary to hard outside were 14 cases,12 cases and 19 cases,and pathological diagnosis was 90. 00%.② The degree of VSD surgery treatment of excellent, good,bad,fair,poor were 22 cases,25 cases,3 cases,0 cases,and the treatment rate is 94. 00%;non-infection group （n = 120） of pa-tients of excellent,good,fair,poor were 56 cases,58 cases,six cases and 0 cases,and the treatment rate is 95. 00%.③ VSD treatment forefoot angle and ulnar deviation were （4. 23 ± 0. 72）° and （10. 22 ± 1. 34）° after treatment. Palmar angle and ulnar deviation were （5. 78 ± 1. 32）° and （13. 13 ± 2. 11 ）°. Comparing palmar angle before and after treatment with ulnar deviation,the differences were statistically significant （ P〈0. 05 ） . Conclusion：MRI spine in elderly patients with acute infection has a high diagnostic value;VSD treatment of elderly patients with acute spinal infection was better,and it is worth to be promoted in clinical application.