摘要
目的探讨金黄色葡萄球菌所致的化脓性脊柱炎的临床诊断、与脊柱结核的鉴别诊断、手术疗效及相关风险。方法回顾性分析2004年1月至2016年12月首都医科大学附属北京胸科医院收治的，在外院误诊为脊柱结核而实际诊断为金黄色葡萄球菌感染所致的化脓性脊柱炎14例；其中男10例，女4例；位于颈椎2例，胸椎5例，腰椎7例。按美国脊柱损伤协会（ASIA）神经功能分级，本组患者中B级1例，C级2例，D级5例，E级6例。14例患者均并发一种或多种其他疾病，其中并发糖尿病8例、肾炎2例、强直性脊柱炎2例、肝硬化1例、高血压6例、肺部严重感染5例。统计患者术后并发症、手术前后疼痛视觉模拟评分（visual analoguescale，VAS）改善情况、术后植骨融合率、术后Cobb角变化等情况，综合上述因素评价手术效果及相关风险。结果本组患者术前均误诊为脊柱结核，经相关检查确诊为金黄色葡萄球菌感染所致的化脓性脊柱炎，均有术前疼痛、截瘫等手术适应证。采用单纯后路内固定并病灶清除术9例，采取后路内固定并前路病灶清除术3例；2例颈椎病变采取颈前路内固定并病灶清除术。随访时间12-36个月，平均22个月，均获得随访。本组患者平均手术时间（187．8±67．5）min，平均术中出血量（460．5±86．4）ml；手术均顺利完成。5例患者出现术后相关并发症：切口延迟愈合3例，术后一过性感染中毒性休克1例，术后菌血症1例。末次随访植骨均获融合；末次随诊ASIA神经功能分级明显改善，D级3例，E级11例。VAS评分术后明显改善，由术前的（7．4±1．4）分降低至末次随访时的（2．3±1．1）分，两者比较差异有统计学意义（t=13．60，P=0．000）。结论金黄色葡萄球菌所致的化脓性脊柱炎术前易误诊为脊柱结核。术后易出现切口不愈合、菌血症等手术风险。在积极处理�
Objective To investigate the clinical diagnosis of pyogenic spondylitis caused by StaDhylococcus aureus, the differential diagnosis with spinal tuberculosis, the operative effect and the related risk factors. Methods We analyzed retrospectively clinical data in 14 cases with pyogenic spondylitis caused by Staphylococcus aureus, which was misdiagnosed as spinal tuberculosis in other hospital, from January 2004 to December 2016. There were 9 males and 5 females, disease involved cervical vertebrae in 2 cases, thoracic vertebrae in 5 cases and lumbar vertebrae in 7 cases. According to the neurological function grade in the American Spinal Injury Association （ASIA）, there were grade B in 1 case, grade C in 2 cases, grade D in 5 cases and grade E in 6 cases. Of 14 cases, all were complicated with one or more other diseases including diabetes mellitus in 8 cases, chronic nephritis in 2 cases, ankylosing spondylitis in 2 cases, liver cirrhosis in 1 case, hypertension in 6 cases and severe pulmonary infection in 5 cases. Surgical effect and related risk factors were evaluated with some characteristics such as postoperative complication, visual analogue scale（VAS） before and after operation, postoperative bone graft fusion rate and the changes of postoperative Cobb angle and so on. Results All the cases were misdiagnosed as spinal tuberculosisbefore operation, and were diagnosed as pyogenic spondylitis caused by Staphylococcu~ aureus with indications of preoperative pain and paraplegia. Surgical methods were performed with simple posterior internal fixation and de bridement in 9 cases, posterior internal fixation and anterior debridement in 3 cases, anterior internal fixation and debridement for cervical spondylosis in 2 cases. All cases were followed up average 22 months ranged from 12 to 36 months. All operations were completed successfully in 14 cases with average operative time （187.8± 67.5） min and average intraoperative bleeding volume （460.5±86.4） ml. Postoperative complications were occurred in 5
作者
范俊
兰汀隆
董伟杰
唐恺
李元
严广璇
秦世炳
FAN Jun , LAN Ting-long, DONG Wei-jie, TANG Kai, LI Yuan, YAN Guang-xuan, QIN Shi-bing(Department of Orthopaedics, Beijing Chest Hospital, Capital Medical University, Beijing Bone and Joint Tuberculosis Treatment Center, Beijing 101149, Chin)
出处
《中国防痨杂志》
CAS
2018年第5期455-461,共7页
Chinese Journal of Antituberculosis
关键词
脊柱炎
葡萄球菌
金黄色
结核
脊柱
诊断
鉴别
外科手术
脊柱融合术
治疗
结果
Spondylitis
Staphylococcu
aureus
Tuberculosis
spinal
Diagnosis
differential
Surgical procedures
operative
Spinal fusion
Treatment outcome
