葡萄球菌相关PS患者临床特征及预后分析

Clinical characteristics and prognosis of patients with staphylococcal-associated pyogenic spondylitis

目的基于临床特征及预后探讨葡萄球菌相关化脓性脊柱炎(PS)患者的病理改变,为临床诊断治疗提供参考。方法回顾性选取2012年1月至2022年10月济南市第八人民医院收治的80例葡萄球菌相关PS患者,统计PS患者基本资料、病变节段分布、实验室指标、CT与MRI影像学特征、预后。结果80例葡萄球菌相关PS患者中,男36例,女44例,≥50岁63例,均存在一定程度腰背疼痛症状,视觉模拟量表(VAS)评分(7.38±0.23)分;病变节段主要分布在T8~T9(15例,18.75%)、L3~L4(12例,15.00%)、L2~L3(10例,12.50%);血小板、红细胞沉降率、白细胞计数、中性粒细胞、铁蛋白、C反应蛋白升高,血清血红蛋白、白蛋白下降。CT检查显示PS病变椎体骨质受损,周围软组织出现肿胀;CT增强扫描显示中心液化坏死区无强化,椎旁软组织边缘强化。MRI检查显示病变椎体异常信号灶,椎旁软组织肿胀,椎间盘破坏区异常信号灶,呈T1WI低信号、T2WI压脂高信号;MRI增强扫描可见明显强化,T2WI压脂高信号。经系统治疗后,所有PS患者VAS评分明显下降[(2.41±0.17)分],预后良好。结论葡萄球菌所引起PS均伴有不同程度腰背疼痛症状,病变节段以T8、T9及L3、L4为主,CT、MRI及C反应蛋白、红细胞沉降率升高可作为诊断PS的有效辅助检查,及时给予相关治疗可有效减轻疼痛,达到治愈效果。

Objective To explore the pathological changes of staphylococcal-associated pyogenic spondylitis(PS)based on laboratory examination,clinical characteristics,and prognosis,and to provide references for its clinical diagnosis and treatment.Methods Eighty patients with staphylococcus-associated PS admitted to Jinan Eighth People's Hospital from January 2012 to October 2022 were selected.Their basic information,lesion segment distribution,laboratory indicators,CT and MRI imaging features and prognosis were statistically analyzed.Results Among the 80 patients were statistically analyzed,there were 36 males and 44 females;63 cases≥50 years old;all of them had low back pain in some degree;their score of Visual Analogue Scale(VAS)was(7.38±0.23).The lesion segments were mainly distributed in T8-T9(15 cases,18.75%),L3-L4(12 cases,15.00%),and L2-L3(10 cases,12.50%).Platelets,erythrocyte sedimentation rate,white blood cell count,neutrophils,ferritin,and C-reactive protein increased,while serum hemoglobin and albumin decreased.The CT examination showed that PS lesions damaged the vertebral bone and surrounding soft tissue swelled.The CT enhanced scan showed no enhancement in the central liquefaction necrosis area,and the edge of the paraspinal soft tissue was enhanced.The MRI examination showed abnormal signal foci in the lesion vertebral body,swelling in the paraspinal soft tissue,abnormal signal foci in the disc destruction area,which showed low signal on T1WI and high signal on T2WI with fat compression.The MRI enhanced scan showed significant enhancement,and T2WI showed high signal with fat compression.After systematic treatment,all the patients showed a significant decrease in VAS score[(2.41±0.17)],and had good prognosis.Conclusion PS caused by staphylococcus is accompanied by varying degrees of low back pain,with the main affected segments being T8,T9,L3,and L4.CT,MRI,C-reactive protein,and erythrocyte sedimentation rate elevation can be used as effective auxiliary tests for the diagnosis of PS.Timely relevant treatments can effectively alleviate the patients'pain and achieve cured effect.