化脓性脊柱炎的诊断与治疗(附67例病例报告)

Diagnosis and treatment of pyogenic spondylitis:a report of 67 cases

目的探讨化脓性脊柱炎的诊治方法及疗效。方法回顾性分析2013年5月—2019年12月收治的67例原发性化脓性脊柱炎患者临床资料,其中15例采用非手术治疗,52例采用手术治疗。治疗前后通过白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP)水平评估临床疗效,采用疼痛视觉模拟量表(VAS)评分及美国脊髓损伤协会(ASIA)分级评估疼痛程度及脊髓功能恢复情况。结果2例采用非手术治疗的患者就诊5 d内死亡,其余患者随访12个月。手术和非手术患者治疗后炎性指标均有所下降,症状改善,所有患者治疗后VAS评分均较治疗前降低;19例伴有神经压迫症状患者,ASIA分级较术前均有所提高。复发7例(7/67,10.45%),按患者情况给予对症处理后症状改善;末次随访时9例患者仍有不同程度局部疼痛。所有手术患者均未出现内固定松动、断裂。结论化脓性脊柱炎需早期诊断、早期治疗,非手术治疗以抗感染为主,手术治疗需严格把握适应证,根据患者情况制订个性化手术方案。

Objective To investigate the methods for the diagnosis and treatment for pyogenic spondylitis and their efficacy.Methods The clinical data of 67 patients with primary suppurative spondylitis from May 2013 to December 2019 were retrospectively analyzed.Among them,15 patients received conservative treatment and 52 underwent surgery.Before and after treatment,the clinical efficacy was evaluated by white blood cell(WBC)count,erythrocyte sedimentation rate(ESR)and level of C-reactive protein(CRP),and the severity of pain and recovery of spinal cord function were evaluated by visual analogue scale(VAS)score and American Spinal Injury Association(ASIA)classification.Results Tow patients who received conservative treatment died within 5 d of admission,and the remaining patients were followed up for 12 months.After treatment,inflammatory markers were decreased,symptoms improved,and VAS scores also decreased in all the patients.In 19 patients with nerve compression symptoms,ASIA grade was improved compared with that before surgery.Seven patients(7/67,10.45%)with recurrence were given symptomatic treatment,and the symptoms were improved.At the final follow-up,9 patients still had different degrees of local pain.No loosening or fracture of internal fixation occurred in all the patients receiving operation.Conclusions Pyogenic spondylitis needs early diagnosis and treatment.Conservative treatment is mainly anti-infection.Surgical treatment should be strictly in accordance with the indications,according to the patient's situation to develop personalized operation plan.