20例葡萄球菌感染所致化脓性脊柱炎的临床特征分析

Clinical analysis of 20 cases of pyogenic vertebral osteomyelitis caused by Staphylococcal infection

为探讨葡萄球菌感染所致化脓性脊柱炎(pyogenic vertebral osteomyelitis,PVO)的临床及影像学特征,本研究回顾性分析了2009年1月—12月上海交通大学附属第六人民医院感染病科收治的20例葡萄球菌感染所致PVO患者的临床特征、实验室检查指标、影像学资料及治疗效果。结果显示,20例PVO患者中金黄色葡萄球菌感染较为多见,85%患者病变在腰椎,50%患者白细胞计数升高,13例发热(65%),12例(60%)出现椎旁脓肿,所有患者C反应蛋白、红细胞沉降率、铁蛋白均升高。计算机断层扫描(computed tomography,CT)平扫示感染椎体骨质破坏;磁共振成像(magnetic resonance imaging,MRI)示病变椎体及椎间盘破坏区异常信号灶,增强后可见明显强化;单光子发射计算机断层扫描(emission computed tomography,ECT)示病变椎体不均匀放射性摄取增高。金黄色葡萄球菌对青霉素耐药率达77.8%。12例椎旁脓肿患者经CT引导下穿刺置管引流加敏感抗生素治疗,临床结局良好。结果提示,金黄色葡萄球菌是葡萄球菌感染所致PVO的主要致病菌,其对青霉素普遍耐药,炎症指标和影像学检查可用于疗效评估及随访,内科保守治疗对PVO有效。

To explore the clinical features and imaging features of pyogenic vertebral osteomyelitis(PVO)caused by Staphylococcus,the clinical characteristics,laboratory examinations and imaging examinations of 20 cases of PVO caused by Staphylococcus admitted to Department of Infectious Diseases,Shanghai Sixth People’s Hospital,Shanghai Jiao Tong University from January 2010 to December 2019 were retrospectively analyzed.The results showed that 20 patients were mainly infected with Staphylococcus aureus,85%occurred in the lumbar spine,12 patients developed paravertebral abscess,13 patients(65%)had fever,and 50%of the patients had elevated white blood cell counts.C-reactive protein,erythrocyte sedimentation rate,and ferritin elevated in all patients.Computed tomography(CT)plain scan showed that the infected vertebral bodies had bone destruction.In magnetic resonance imaging(MRI)vertebral bodies and intervertebral disc destruction area had abnormal signal focus.Emission computed tomography(ECT)showed uneven radioactive uptake of the diseased vertebral bodies.Over 80%of Staphylococcus aureus was not sensitive to penicillin.Twelve patients with paravertebral abscess recovered by CT-guided drainage combined with sensitive antibiotic treatment.It is concluded that Staphylococcus aureus is the main pathogenic bacterium of pyogenic vertebral osteomyelitis caused by Staphylococcus,which is generally resistant to penicillin.Imaging examination is of great value in the diagnosis of this disease.The inflammatory indicators and MRI could be used in therapeutic effect evaluation and conservative treatment is effective.