腰椎术后迟发性椎间隙感染临床特征及诊治探讨

Clinical characteristics,diagnosis and treatment of delayed intervertebral space infection after lumbar surgery

目的近年来,随着腰腿痛患病率上升,腰椎手术量也在逐年递增,由此导致的腰椎术后椎间隙感染发病率也在不断增加。然而椎间隙感染的临床特征往往不典型,特别是迟发性椎间隙感染,临床上容易被漏诊或者误诊,且治疗较为棘手。本研究探讨腰椎术后迟发性椎间隙感染临床特征及诊治措施,为临床诊治提供参考。方法收集2011-06-01-2017-12-31南华大学附属第二医院脊柱外科收治的腰椎术后出现迟发性椎间隙感染15例患者临床资料。所有患者均常规完善腰椎MR、CT、血常规、血沉和C反应蛋白检查,结合临床特征,确诊为迟发性椎间隙感染。及时进行抗生素干预治疗,观察其症状缓解情况、炎性指标及影像学资料变化情况。结果15例患者发生20个椎间隙感染。患者均出现腰背痛症状,少部分患者有轻微下肢症状;白细胞、血沉和C反应蛋白均升高;MR结果显示,椎间隙、相邻椎体甚至椎旁异常信号。抗生素干预治疗好转后,炎性指标及MR异常信号趋于正常,腰背痛症状明显缓解。结论腰椎术后迟发性椎间隙感染症状相对较轻,早期容易漏诊及误诊,MR对其早期诊断敏感性较高,早期诊断并及时治疗是其诊治的关键。

OBJECTIVE In recent years,with the increase of the prevalence of lumbocrural pain,the amount of lumbar operation is increasing year by year,resulting in an increase in the incidence of intervertebral space infection after the operation of the lumbar spine.However,the clinical characteristics of the intervertebral space infection are often not typical,especially the delayed disc space infection.It is easy to be missed or misdiagnosed clinically,and the treatment is more difficult.This study is aimed at discussing the clinical features and the treatment measures of delayed disc space infection after the lumbar vertebra operation,and provides a reference for the diagnosis and treatment of delayed disc space infection after the operation of the lumbar vertebra.METHODS Fifteen patients with delayed intervertebral space infection after lumbar surgery in our department from June 1,2011 to December 31,2017 were selected.All patients underwent routine examination of lumbar MR,CT,blood routine,erythrocyte sedimentation rate(erythrocyte sedimentation rate)and C-reactive protein examination,combined with the clinical characteristics of the patients.Delayed intervertebral space infection was diagnosed and effective intervention treatment was carried out in time to observe the relief of symptoms,inflammatory indexes and the changes of imaging data.RESULTS A total of 20 intervertebral space infections occurred in 15 patients,all of them had symptoms of low back pain,a small number of patients had mild lower extremity symptoms,white blood cells,erythrocyte sedimentation rate and C-reactive protein increased.MR showed abnormal signals in intervertebral space,adjacent vertebrae and even paravertebrae.After the treatment,the inflammatory index and MR abnormal signal tended to be normal,and the symptoms of low back pain were obviously relieved.CONCLUSION The symptoms of late intervertebral space infection after lumbar surgery are relatively mild,and it is easy to miss diagnosis and misdiagnose in the early stage.MR is sensitive to its early diagnosis.Early diagnosis and timely treatment is the key to the diagnosis and treatment of delayed intervertebral space infection after lumbar surgery.