原发性椎间隙感染的诊断与外科治疗

目的探讨原发性椎间隙感染的诊断与外科治疗方法。方法回顾性分析1999年5月～2005年7月收治的原发性椎间隙感染19例（其中胸椎4例、腰椎15例）患者的临床资料及治疗效果。所有患者均无椎间盘手术病史及脊柱封闭或穿刺史，纳入诊断均靠术中术后病理确诊。全部病例均因非手术治疗无效后行病灶清除、植骨并内固定术。术中病灶清除后局部应用抗生素，术后继续抗感染治疗。结果所有患者术后腰背部疼痛、活动受限等症状明显缓解，体温正常。术前伴有脊髓神经损伤的9例患者术后神经功能均得到不同程度恢复。19例中仅有l例术后脓液细菌培养结果提示为金黄色葡萄球菌生长，其余均为无菌生长。所有病例术后病理结果均提示有中性粒细胞、浆细胞或巨噬细胞浸润，考虑炎性改变。随访13～42个月，平均25个月，均无复发。影像学检查示椎体序列良好，植骨节段均骨性融合，无内固定器松动、断裂。术前误诊为“脊柱结核”8例。结论MRI有利于原发性椎间隙感染的早期诊断，但确诊需以病理为准；病灶彻底清除、植骨并加强内固定有利于治疗该疾病，但需严格掌握手术适应证。

Diagnosis and surgical procedures for primary infection of intervertebral space

Objective To explore the diagnosis and surgical management for primary infection of intervertebral space. Methods From May 1999 to July 2005, 19 patients with primary infection of intervertebral disc were analyzed retrospectively. The position of infection located at thoracic spine in 4 cases and at lumbar spine in 15 cases. Their clinical course and outcome were studied. None of all had previous spinal surgery or spinal injection, and their diagnosis were confirmed by pathology. All patients were treated by debridement, bone autograft and internal fixation after conservative treatment was failed. Antibiotics was used in the local focus during operation, and was continued to be administered by vein after surgery. Results Postoperatively, all patients experienced significant relief of back pain, improving in the function of movement, and no fever. 9 patients showed improved neurological status (at least one grade improvement on Frankel's functional classification).Only one of 19 cases had a positive result of Staphylococcus species. The period of follow-up lasted 13 months to 42 months with a mean of 25 months. There was no recurrence of infection. Postoperative radiological evaluation revealed that implants were stable, there are no phenomena of prosthesis subsidence, hook dislodgment and failure restoration of spinal segments height. Solid bony fusion was obtained in all patients. 8 patients were mistaken diagnosed for spinal tuberculosis. Conclusion MRI plays a key role in early diagnosis of primary infection of intervertebral space. Pathology is important for confirmed diagnosis. Pathologic vertebral resection, autograft and internal fixation are effective treatments in the management of primary infection of intervertebral space, but the indication of operation must be strict.