针刺治疗导致化脓性脊柱感染的临床特点与治疗措施

目的 分析经针刺治疗后导致化脓性脊柱感染的临床特点及治疗措施。方法 回顾性分析2015年1月至2020年10月西南医科大学附属医院骨科收治的针刺治疗后导致脊柱化脓性感染11例患者的临床资料。其中，男9例，女2例；年龄47 ～ 69岁，平均（57.8±8.2）岁。分析患者的临床资料，包括症状、体征、血培养、炎性指标、脊柱影像学资料（X线、CT三维重建及MRI）、治疗措施，使用疼痛视觉量表（VAS）评估治疗前后局部疼痛改善情况，使用美国脊柱损伤协会运动功能分级（AISA）评估治疗前后神经功能改善。结果 所有患者均获随访，术后随访14 ～ 38个月，平均随访（25.7±9.0）个月。末次随访时，除1例术前ASIA评分A级患者神经功能无明显变化外，其余患者的VAS评分、神经功能、炎性指标均获得显著改善。随访期内无1例复发或迁延性慢性感染。结论 针刺治疗史、脊柱局部疼痛、神经功能异常、炎性指标异常及特征性影像学改变是此类化脓性脊柱感染的主要临床特征。MRI有利于早期明确诊断。及时诊断及规范有效抗感染治疗的前提下，外科手术治疗使多数患者获得满意疗效，且可缩短抗生素的使用时间。

Clinical characteristics and treatment of septic spinal infection caused by inappropriate acupuncture

Objective To analyze the clinical characteristics and treatment measures of septic spinal infection caused by inappropriate acupuncture treatment.Methods We retrospectively analyzed the clinical data of 11 patients admitted to the Affiliated Hospital of Southwest Medical University from January 2015 to October 2020 after inappropriate acupuncture treatment resulting in septic infection of the spine. Among them, 9 cases were male and 2 cases were female. The ages ranged from 47 to 69 years, with an average of (57.8±8.2) years. The patients'' clinical data, including symptoms, signs, blood cultures, inflammatory indexes, spinal imaging data (X-ray, CT triple reconstruction and MRI), and treatment measures were analyzed, and the improvement of local pain before and after treatment was assessed using the visual analogue scale (VAS), and the improvement of neurological function before and after treatment was assessed using the American Spinal Injury Association (AISA).Results All patients were followed up for 14-38 months, with an average of (25.7±9.0) months. At the time of the final follow-up, the VAS score, neurological function, and inflammatory indexes were significantly improved in all patients except for one patient with preoperative ASIA score grade A who had no significant recovery of neurological function. There was no case of recurrent or prolonged chronic infection during the follow-up period.Conclusion History of acupuncture treatment, localized pain in the spine, abnormal neurological function, abnormal inflammatory indicators and characteristic imaging manifestations are the main clinical features of this type of infection. MRI facilitates early and clear diagnosis. With timely diagnosis and standardized and effective anti-infective treatment, surgical treatment leads to satisfactory results in most patients and shortens the duration of antibiotic use.