化脓性脊柱炎的临床特征、鉴别诊断及治疗进展

The clinical diagnosis and treatment of pyogenic spondylitis and the differential diagnosis of atypical spinal tuberculosis

虽然化脓性脊柱炎是一种罕见的感染性疾病,但随着老年人和免疫功能低下患者的增多,其发病率也在增加。其诊断通常很困难,适当的影像学、血培养或活组织检查是早期诊断的必要条件。大多数患者可以采用非手术治疗,脊髓或马尾压迫伴进行性神经功能缺损的患者或保守治疗失败的患者应接受手术治疗。由于化脓性脊柱炎的非特异性临床发作易与脊柱结核及布鲁杆菌性脊柱炎、退行性疾病等混淆,误诊漏诊率较高,容易导致患者脊柱畸形、神经功能受损、瘫痪,甚至死亡。因此,化脓性脊柱炎的早期、准确诊断对于及时有效的治疗及减少脊柱畸形和功能障碍的发生具有重要意义。

Pyogenic spondylitis is an infrequent infection.Its incidence is increasing because of the growing number of elderly people and immunocompromised patients.The diagnosis of pyogenic spondylitis is usually very difficult and appropriate imaging,blood cultures and/or biopsy are necessary for early diagnosis.Most cases can be treated with non-operatively,but patients with spinal cord or cauda equine compression with progressive neurological deficits and/or patients with failure of conservative treatment should receive surgical treatment.Because of the nonspecific clinical attack of pyogenic spondylitis,it is easy to be confused with spinal tuberculosis,brucellosis spondylitis and other degenerative diseases.The misdiagnosis and missed diagnosis rate is high,which can easily lead to spinal deformity and neurological impairment,paralysis,and even death.So early and accurate diagnosis of pyogenic spondylitis is important for timely and effective treatment and reducing the occurrence of spinal deformity and dysfunction.