摘要
目的评价椎间盘炎的抗生素预防与介入治疗效果并探讨其影像学表现。材料与方法对２４只新西兰兔采用直视下向椎间盘内注入细菌的方法，制作椎间盘炎动物模型，并随机分为非治疗组、抗生素预防组、抗生素治疗组、介入治疗组。抗生素预防组在椎间盘炎发生前静脉滴注克林霉素３天；抗生素治疗组在椎间盘炎发生１周后静脉给药４周；介入治疗组在椎间盘炎发生１周后用经皮椎间盘切除术（ＰＬＤ）的方法切除部分间盘组织，同时静脉给药１周。实验动物在间盘组织注入细菌后２周与４周，分别行常规Ｘ线，ＣＴ及ＭＲＩ检查。６周后处死动物，实验区脊柱标本送病理学检查，并作细菌培养。结果非治疗组与抗生素治疗组，实验区椎间隙变窄，椎体骨质破坏及增生，尸解显示间盘组织靡烂，椎体边缘骨质破坏；细菌培养多为阳性。介入治疗组，影像学表现为椎间隙变窄，病理检查显示髓核组织被纤维组织取代，细菌培养阴性。抗生素预防组，无椎间盘炎发生。结论ＭＲＩ是发现椎间盘炎的较敏感方法；抗生素预防用药是防止椎间盘炎发生的关键措施；椎间盘炎发生后，单纯静脉给予抗生素不能阻止其病理进程，而介入治疗可有效阻止椎间盘炎的病理进程。
Purpose To assess the role of antibiotic and interventional radiology in prevention and treatment of discitis and analyze the imaging manifestations of discitis. Materials and methods 24 rabbits was used to make discitis models with injecting bacteria directly into discs,and were classified into 4 groups randomly, 6 cases per group: non-treatment group, in prophylactic antibiotic group, therapeutic antibiotics group, and interventional treatment group. In prophylactic antibiotics group,the rabbits were administered intravenously clindamycin before 3 days the inoculation of bacteria to disc. In therapeutic antibiotics group, 4-week course of intravenous antibiotics was commenced 1 week after the bacterial inoculation. In interventional treatment group the rabbits were performed with PLD. 1 week after the inoculation, simultaneous intravenous antibiotics were given for a period of 1 week. 2 or 4 weeks after inoculation, all rabbits lumbar spines were examined by x-rays, CT,MRI respectively. Needle biopsies of nuclear pulpous were obtained from experiment regions of lumbar spine were removed for pathological examination. Results in non-treatment group and therapeutic antibiotics group,all of the discs inoculated with bacterial developed radiographic and pathological evidence of discitis, including intervertebral space narrowing, in flammation changes of disc tissue, and destruction of end-plates, bacteria was isloated from biopsy tissue. In prophylactic antibiotics group, none of discs developed radiographic and pathological evidence of discitis, the bacterial culture was negative. In interventional treatment group,intervertebral space narrow was observed in medical image and fibrosis changes were observed in nucleus regions, there is no evidence with destruction of end-plate, the bacteria culture was negative. Conclusion MRI was a relative sensitive method to find discitis, the prophylactic antibiotics was a key maneuver to prevent from discitis. The intravenous antibiotics were unable to affect the course of
出处
《医学影像学杂志》
1999年第4期228-231,共4页
Journal of Medical Imaging
