脊柱化脓性骨髓炎的诊断及现代外科治疗.doc

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1、脊柱化脓性骨髓炎的诊断及现代外科治疗作者：刘洪HirokazuTshihara张腾云【摘要】［目的］探究脊柱化脓性骨髓炎的特点及外科治疗方法。［方法］39例脊柱化脓性骨髓炎患者均行一期前路病灶清除加椎间植骨术。分析其临床表现、实验室、病原学及影像学特点和疗效。［结果］随访2~17年，平均8.5年。所有患者腰背疼痛均有缓解，其中17例疼痛完全消失，其余22例有时轻微疼痛。下肢神经功能除1例感觉障碍加重，均有不同程度改善，临床症状和体征改善率20%〜100%,平均75.6%o所有患者均获得骨性融合，融合时间2~6个月，平均4个月。血沉从术前平均73mm/h恢复到术

2、后平均29mm/h,而C反应蛋白全部恢复正常。无与手术直接相关的死亡及其他并发症。病原学结果：19例(48.7%)患者细菌培养阳性:金黄色葡萄球菌阳性10例，表皮葡萄球菌2例，大肠杆菌2例，绿脓杆菌2例，肺炎链球菌1例，肺炎克雷白杆菌1例，弗氏柠檬酸杆菌1例。［结论］患者本身的基础疾患是导致脊柱化脓性骨髓炎发病的重要因素之一，不仅金黄色葡萄球菌可以致病，某些条件致病菌或非致病菌如大肠杆菌及表皮葡萄球菌等也可以导致脊柱化脓性骨髓炎的发病;C反应蛋白比ESR及白细胞计数更为敏感，可用于脊柱化脓性骨髓炎的诊断及判定疗效的重要参考指标；MRI对脊柱化脓性骨髓炎的诊断更

3、为敏感、特异及准确；一期前路病灶清除植骨术是治疗脊柱化脓性骨髓炎安全有效的手术方法。【关键词】脊柱化脓性骨髓炎外科治疗Diagnosisandmodernsurgicaltreatmentofpyogenicosteomyelitisofthespine/7Abstract：[Object!ve]Toexplorethecharacteristicsandmanagementofpyogenicosteomyelitisofthespine.[Method]Thirtyninepatientswithpyogenicosteomyelitisofthespin

4、e,whoweretreatedbysinglestageanteriordebridementandinterbodybonegraftfusion,wereincluded.Theclinicalpresentations,laboratory,biologicalaswel1asradiologicalcharacteristicsandsurgicaloutcomeswereinvestigated.[Result]Themeanfollowupdurationwas8.5years,rangingfrom2to17years.Allthepatien

5、tshadmarkedimprovementintheirbackpain,17ofwhomobtainedcompleterecovery,theremaining22patientshadoccasionalmi1dpain.Sensorydeficitaggravatedin1patient,theremaining38patientshadmarkedimprovementintheneurologicalfunctionofthelowerextremity.Therecoveryrateofclinicalsymptomsandsignsrange

6、dfrom20%to100%(averaged,75.6%).Bonyfusionwasobtainedinal1thepatientsin4monthsonaverage(ranged,2〜6months).ESRdecreasedfrom73mm/hpreoperativelyto29mm/hat4monthsafteroperation,whileCreactiveproteindecreasedtonormal.Therewasnodeathandnoothercomplicationrelatingtoopertion.Speciesofpathog

7、en:culturepositivein19cases(48.7%).Ofthese,S.aureusin10cases,etal.[Conclusion]Theunderlyingdiseasesofpatientswereriskfactorsofpyogenicosteomyelitisofthespine,pathogensinvolvednotonlyS.aureusbutalsootherlowvirulentorganisms.CRPwasmoresensitivethanESRorwhitecellcounts,itmayalsobethepa

8、rametertoevaluateou