【摘要】：目的:探討成人原發(fā)性椎間盤炎的診斷和治療方法。方法:回顧性分析我院自2005年3月~2013年12月收治的20例成人原發(fā)性椎間盤炎,平均年齡56歲。主要臨床癥狀表現(xiàn)為腰背部疼痛伴有低熱,均無創(chuàng)傷性脊柱手術(shù)史及穿刺史。其中8例分別合并有糖尿病、尿路感染、中風史。入院前誤診為腰椎結(jié)核10例。全組血沉均升高,MRI檢查可見局部信號改變。均先予以靜脈行抗生素保守治療,12例保守治療無效后行病灶清除、內(nèi)固定術(shù)。結(jié)果:所有患者癥狀均明顯緩解,手術(shù)及非手術(shù)行穿刺患者病理結(jié)果均提示炎性改變,術(shù)前細菌培養(yǎng)1例提示金黃色葡萄球菌感染。隨訪12~116月,平均隨訪41月。8例保守治療患者中,6月后病變間隙逐漸自行融合,2例遺留輕度腰痛。12例手術(shù)治療1例術(shù)后4月復發(fā),經(jīng)保守治療6周后痊愈,行手術(shù)治療患者X線片顯示內(nèi)固定無松動、斷裂。結(jié)論:成人原發(fā)性椎間盤炎臨床表現(xiàn)無特異性,早期診斷較為困難,血沉及MRI檢查具有重要價值,一旦明確診斷,應盡早應用抗生素保守治療,如保守治療無效采用手術(shù)治療,清除病灶,有效控制感染,緩解癥狀。
[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.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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