成人原发性化脓性脊柱炎的诊疗与临床研究

Diagnosis, Treatment and Clinical Study of Adult Primary Pyogenic Spondylitis

摘要: 目的：探讨成年人原发性化脓性脊柱炎的临床特征、诊断、治疗及预后。方法：回顾性分析我科自2016年1月~2019年2月收治的26例成人原发性化脓性脊柱炎的临床资料。结果：16例行手术治疗，10例行保守治疗。所有患者症状均明显缓解，病理学检查均提示化脓性炎性改变，阳性14例，阴性12例。随访6~24个月，平均随访16个月。1例复发后痊愈。术后Oswestry Disability Index (ODI)、疼痛视觉模拟评分(VAS)明显下降，与术前相比差异有统计学意义(P < 0.05)。结论：成人原发性化脓性脊柱炎临床表现无特异性，早期诊断较为困难，易误诊漏诊。确诊有赖于MRI检查、活检或细菌学检查。对于无脊柱不稳、脊髓神经压迫症状、硬膜外血肿、进行性恶化的患者可单纯应用抗生素治疗；对于合并脊柱不稳、脊髓神经压迫症状、硬膜外血肿、进行性恶化的患者应采取外科手术联合抗生素治疗。

Abstract: Objective: To investigate the clinical features, diagnosis, treatment and prognosis of primary suppurative spondylitis in adults. Methods: The clinical data of 26 adult patients with primary suppurative spondylitis admitted to our department from January 2016 to February 2019 were retrospectively analyzed. Results: 16 patients received surgical treatment and 10 received conservative treatment. The symptoms of all the patients were significantly relieved, and the pathological examination showed suppurative inflammatory changes, with 10 positive cases and 16 negative cases. The patients were followed up for 6~24 months, with an average of 16 months. One patient recovered after recurrence. Postoperative Oswestry Disability Index (ODI) and Visual Analogue Scale of pain (VAS) were significantly decreased, with statistically significant differences compared with those before surgery (P < 0.05). Conclusion: The clinical manifestation of adult primary suppurative spondylitis is not specific; early diagnosis is difficult, easy to be misdiagnosed and missed diagnosis. The diagnosis depends on MRI, biopsy, or bacteriology. The patients without spinal instability, spinal nerve compression symptoms, epidural hematoma, and progressive deterioration can be treated with antibiotics alone; the patients with spinal instability, spinal nerve compression symptoms, epidural hematoma, and progressive deterioration should be treated with surgery combined with antibiotics.