成人原发性椎间盘炎的诊断和治疗

发布时间：2018-10-19 10:11

【摘要】：目的:探讨成人原发性椎间盘炎的诊断和治疗方法。方法:回顾性分析我院自2005年3月~2013年12月收治的20例成人原发性椎间盘炎,平均年龄56岁。主要临床症状表现为腰背部疼痛伴有低热,均无创伤性脊柱手术史及穿刺史。其中8例分别合并有糖尿病、尿路感染、中风史。入院前误诊为腰椎结核10例。全组血沉均升高,MRI检查可见局部信号改变。均先予以静脉行抗生素保守治疗,12例保守治疗无效后行病灶清除、内固定术。结果:所有患者症状均明显缓解,手术及非手术行穿刺患者病理结果均提示炎性改变,术前细菌培养1例提示金黄色葡萄球菌感染。随访12~116月,平均随访41月。8例保守治疗患者中,6月后病变间隙逐渐自行融合,2例遗留轻度腰痛。12例手术治疗1例术后4月复发,经保守治疗6周后痊愈,行手术治疗患者X线片显示内固定无松动、断裂。结论:成人原发性椎间盘炎临床表现无特异性,早期诊断较为困难,血沉及MRI检查具有重要价值,一旦明确诊断,应尽早应用抗生素保守治疗,如保守治疗无效采用手术治疗,清除病灶,有效控制感染,缓解症状。
[Abstract]:Objective: to investigate the diagnosis and treatment of adult primary intervertebral disc disease. Methods: twenty adult patients with primary intervertebral disc disease from March 2005 to December 2013 were retrospectively analyzed. The average age was 56 years. The main clinical symptoms were lumbar and back pain with low fever and no history of traumatic spinal surgery or puncture. Among them, 8 cases were complicated with diabetes, urinary tract infection and stroke. 10 cases were misdiagnosed as lumbar tuberculosis before admission. The erythrocyte sedimentation rate (ESR) was increased in all patients, and local signal changes were observed on MRI. All patients were treated with antibiotic conservative therapy first, 12 cases were treated with debridement and internal fixation after ineffective conservative treatment. Results: all the patients' symptoms were relieved obviously. The pathological results of the patients undergoing puncture and non-operation showed inflammatory changes, and one case of bacterial culture before operation suggested Staphylococcus aureus infection. The follow-up ranged from 12 to 116 months, with an average follow-up of 41 months. In 8 patients with conservative treatment, the lesion space gradually fused after 6 months, and 2 patients with mild low back pain were left behind. 12 cases were treated with surgical treatment for 4 months and recovered after 6 weeks of conservative treatment. X-ray films showed no loosening and rupture of internal fixation in patients undergoing surgical treatment. Conclusion: the clinical manifestations of adult primary intervertebral disc disease are not specific, and the early diagnosis is difficult. ESR and MRI are of important value. Once the diagnosis is clear, antibiotics should be used conservatively as soon as possible, if conservative treatment is not effective, surgical treatment should be used as soon as possible. Clear the focus, effectively control the infection and relieve the symptoms.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】