化脓性脊柱炎20例的临床特点分析

Analysis of clinical characteristics of 20 patients with pyogenic spondylitis

目的：探讨综合患者临床表现、实验室检查及影像学变化对化脓性脊柱炎进行诊断的价值,总结化脓性脊柱炎患者的临床特点.方法：回顾性分析2012年3月至2015年3月经组织病理学确诊的20例化脓性脊柱炎患者临床资料,男9例,女11例;年龄43～72岁,平均58.9岁.颈椎3例,胸椎7例,腰椎10例.分析患者在接受治疗前的临床症状,体征,实验室检查[包括血液分析、红细胞沉降率（ESR）和C-反应蛋白（CRP）],影像学检查（包括X线片、CT及MRI）,应用疼痛视觉模拟评分（VAS）记录患者治疗前局部疼痛情况.结果：治疗前所有患者有患椎处疼痛,VAS9分4例,8分6例,7分1例,3分6例,2分3例.其中7例伴有神经症状,11例伴有夜间疼痛加剧,10例伴有发热.白细胞、中性粒细胞计数升高5例,正常15例;CRP升高19例,正常1例;20例患者ESR均升高.X线片显示椎间隙均变窄,13例伴有椎体的骨质破坏;CT显示20例患者有病变椎体骨质破坏、硬化.MRI检查显示病变椎体在T1像上表现为不均匀中等偏低信号,在T2像上16例呈不均匀高信号,2例呈均匀高信号,2例呈高信号为主的混杂信号.13例患者进行了手术治疗,7例患者接受了保守治疗,治疗后患者VAS评分明显改善后出院.结论：化脓性脊柱炎容易误诊漏诊,在早期诊断中应综合分析患者临床表现、实验室检查及影像学表现特点,为下一步诊疗方案提供依据.

Objective：To investigate the diagnostic value of clinical manifestation,laboratory examination and imaging changes for pyogenic spondylitis and to summarize the clinical characteristics of patients with pyogenic spondylitis.Methods：The clinical data,of 20 patients with pyogenic spondylitis were diagnosed by histopathological examination from March 2012 to March 2015,were retrospectively analyzed.There were 9 males and 11 females,aged from 43 to 72 years old with an average of 58.9 years.Included 3 cases of cervical vertebrae,7 cases of thoracic vertebrae,10 cases of lumbar vertebrae.Patients of blood analysis,erythrocyte sedimentation rate （ESR）,C reactive protein （CRP）,X-rays,CT and MRI were performed before treatment.Visual analogue scale （VAS） was used to evaluate the pain of patients suffering from vertebral pain.Results：Allthe patients had suffered from vertebral pain before treatment.VAS was 9 points in 4 cases,8 points in 6 cases,7 points in 1 case,3 points in 6 cases,and 2 points in 3 cases.Among them,7 patients complicated with neurological symptoms,11 with aggravating night pain,10 with fever.WBC and Neutrophil count （NEU） of 5 cases were increased and other 15 cases were normal;CRP of 19 cases were increased and 1 case was normal;ESR of all 20 cases were increased.X-rays showed the intervertebral space narrowing in all 20 cases,13 cases complicated with destruction of vertebral body;CT showed the lesions of vertebral body in the 20 cases and complicated with destruction,sclerosis of sclerotin;MRI showed that the lesions of the vertebral body in the T1 image had uneven medium low signal,in the T2 image of the 16 cases had uneven high signal and 2 cases had uniform and high signal,2 cases had main high signal compliated with mixed signal.Thirteen patients underwent surgical treatment and 7 patients received conservative treatment,and the patients left hospital while VAS had significantly improved after treatment.Conclusion：Pyogenic spondylitis is easy to be misdiagnosed or missed in clinic.It can be combined with the clinical manifestations,laboratory examination and imaging characteristics in order to make a definite diagnosis for purulent spondylitis in early.