化脓性脊柱炎20例的临床特点分析

目的 :探讨综合患者临床表现、实验室检查及影像学变化对化脓性脊柱炎进行诊断的价值,总结化脓性脊柱炎患者的临床特点。方法:回顾性分析2012年3月至2015年3月经组织病理学确诊的20例化脓性脊柱炎患者临床资料,男9例,女11例;年龄43~72岁,平均58.9岁。颈椎3例,胸椎7例,腰椎10例。分析患者在接受治疗前的临床症状,体征,实验室检查[包括血液分析、红细胞沉降率(ESR)和C-反应蛋白(CRP)],影像学检查(包括X线片、CT及MRI),应用疼痛视觉模拟评分(VAS)记录患者治疗前局部疼痛情况。结果 :治疗前所有患者有患椎处疼痛,VAS9分4例,8分6例,7分1例,3分6例,2分3例。其中7例伴有神经症状,11例伴有夜间疼痛加剧,10例伴有发热。白细胞、中性粒细胞计数升高5例,正常15例;CRP升高19例,正常1例;20例患者ESR均升高。X线片显示椎间隙均变窄,13例伴有椎体的骨质破坏;CT显示20例患者有病变椎体骨质破坏、硬化。MRI检查显示病变椎体在T1像上表现为不均匀中等偏低信号,在T2像上16例呈不均匀高信号,2例呈均匀高信号,2例呈高信号为主的混杂信号。13例患者进行了手术治疗,7例患者接受了保守治疗,治疗后患者VAS评分明显改善后出院。结论:化脓性脊柱炎容易误诊漏诊,在早期诊断中应综合分析患者临床表现、实验室检查及影像学表现特点,为下一步诊疗方案提供依据。

Analysis of clinical characteristics of 20 patients with pyogenic spondylitis

Objective:To investigate the diagnostic value of clinical manifestation,laboratory examination and imaging changes for pyogenic spondylitis and to summarize the clinical characteristics of patients with pyogenic spondylitis.Methods:The clinical data,of 20 patients with pyogenic spondylitis were diagnosed by histopathological examination from March 2012 to March 2015,were retrospectively analyzed. There were 9 males and 11 females,aged from 43 to 72 years old with an average of 58.9 years. Included 3 cases of cervical vertebrae,7 cases of thoracic vertebrae,10 cases of lumbar vertebrae. Patients of blood analysis,erythrocyte sedimentation rate(ESR),C reactive protein(CRP),X-rays,CT and MRI were performed before treatment. Visual analogue scale (VAS) was used to evaluate the pain of patients suffering from vertebral pain.Results:All the patients had suffered from vertebral pain before treatment. VAS was 9 points in 4 cases,8 points in 6 cases,7 points in 1 case,3 points in 6 cases,and 2 points in 3 cases. Among them,7 patients complicated with neurological symptoms,11 with aggravating night pain,10 with fever. WBC and Neutrophil count (NEU) of 5 cases were increased and other 15 cases were normal;CRP of 19 cases were increased and 1 case was normal;ESR of all 20 cases were increased. X-rays showed the intervertebral space narrowing in all 20 cases,13 cases complicated with destruction of vertebral body;CT showed the lesions of vertebral body in the 20 cases and complicated with destruction,sclerosis of sclerotin;MRI showed that the lesions of the vertebral body in the T1 image had uneven medium low signal,in the T2 image of the 16 cases had uneven high signal and 2 cases had uniform and high signal,2 cases had main high signal compliated with mixed signal. Thirteen patients underwent surgical treatment and 7 patients received conservative treatment,and the patients left hospital while VAS had significantly improved after treatment.Conclusion:Pyogenic spondylitis is easy to be misdiagnosed or missed in clinic. It can be combined with the clinical manifestations,laboratory examination and imaging characteristics in order to make a definite diagnosis for purulent spondylitis in early.