颈椎术后低毒性感染的中西医治疗附病例一则

Treating one case of low toxicity infection after cervical surgery in the integrative medicine

颈椎术后的低毒性感染发病率低,但由于发病部位特殊,发病初期症状隐匿,极易造成神经脊髓损伤,引发严重并发症,影响患者术后恢复,威胁患者生命安全。由于其体征、实验室检查缺乏特异性,故易发生误诊误治。颈椎术后的低毒性感染属于骨的低毒性感染,其本质是骨的一种慢性炎症,临床上常将其归于亚急性骨髓炎范畴。颈椎术后的低毒性感染发病机制与手术创伤密切相关,创伤后骨膜下出血是发病的重要因素。其感染途径以医源性及血源性感染为主,感染病菌以金黄色葡萄球菌最为常见,临床表现以多样的感染性症状为主。中医将其归为“附骨疽”“附骨痈”“阴疽”“骨蚀”等范畴,是素体虚弱或病后体虚,正气不足,邪毒乘虚而入所致,正气虚弱是本病的发病基础。目前对于颈椎术后低毒性感染尚无统一的治疗方法,临床上常根据患者的具体表现对症治疗,中医则多依据不同分期辨证治疗,内治与外治并举,祛邪与扶正兼施。目前报道的骨低毒性感染多位于四肢,尚无颈椎术后低毒性感染病例报道。文章总结了颈椎感染的发病机制和中西医治疗,并报道了1例中西医结合治疗颈椎术后低毒性感染病例,以期帮助更多颈椎术后低毒性感染患者尽早诊断、更高效治疗,避免出现漏诊误诊。

The incidence of low toxicity infection after cervical spine surgery is low,but due to the special site of the disease and hidden symptoms at the beginning of the disease,it is easy to cause neurospinal cord injury,leading to serious complications,which affects the postoperative recovery of patients,and threatens the life safety of patients.Due to the lack of specificity in physical signs and laboratory examination,it is easy to be misdiagnosed and mistreated.Low toxicity infection after cervical spine surgery belongs to low toxicity infection of bone,which is essentially a chronic inflammation of bone and is often classified as subacute osteomyelitis in clinical practice.The pathogenesis of low toxicity infection after cervical spine surgery is closely related to surgical trauma,and subperiosteal hemorrhage after trauma is an important factor in the onset of the disease.The main routes of infection are iatrogenic and bloodborne,with Staphylococcus aureus being the most common pathogen.The clinical manifestations are mainly diverse infectious symptoms.Traditional Chinese medicine categorizes it into categories such as bone gangrene,bone carbuncle,Yin(阴) gangrene,and bone erosion.It is caused by the weakness of the body or the deficiency of the body after the disease,the deficiency of healthy Qi(气),and the invasion of evil toxins.The weakness of healthy Qi is the pathogenetic basis of this disease.At present,there is no unified treatment method for low toxicity infections after cervical spine surgery.In clinical practice,symptomatic treatment is often based on the specific symptoms of patients.Traditional Chinese medicine often treats patients based on different stages of differentiation of symptoms and signs,with both internal and external treatment,as well as eliminating pathogenic factors and strengthening the body.At present,reports of low toxicity infections in bone are mostly located in the limbs,and there are no reports of low toxicity infections after cervical spine surgery.This article summarizes the pathogenesis of cervical spine infection and the treatment in the integrative medicine,and reports one case of low toxicity infection after cervical spine surgery treated in the integrative medicine.It is hoped that more patients with low toxicity infections after cervical spine surgery will be diagnosed as soon as possible,treated more efficiently,so as to avoid missed diagnosis and misdiagnosis.