腰椎间盘术后椎间盘炎的诊治

目的：探讨腰椎间盘术后椎间盘炎的病因。早期诊断和治疗问题。方法：分析10例术后腰椎间盘炎的临床表现、血象、血流变化、血和病灶细菌培养、腰椎X线平片、CT、MRI所见在发病后的敏感程度，比较3例非手术与7例经前路腹膜后（2例联合后入路）病灶清除，一期椎间植骨融合本治疗的效果。结果：不同程度的发热、痉挛性腰痛、血流增快是本病的特点。MRI、CF、X线片三者的诊断敏感性存在时间差，分别约为发病后1、3、5周。仅2例血和病灶细菌培养均阳性。前路减压植骨融合术减少全身性抗生素和镇痛剂的使用量，明显缩短病程。结论：ESR、MRI对早期确诊、引导手术价值较高。高热、痉挛性腰痛、血沉增快三者具一持续2周得不到控制，可考虑及早手术。手术疗法近期效果更为确切。

The Diagnosis and Treatment of Postoperative Discitis of the Lumbar Spine

Objective: To approach postoperative discitis of the lumbar spine from the pathogeny, early diagnosis and different methods of treatment. Methods: The clinical manifestations, ESR, bacteriology, plain X - ray, CT and MRI of 10 cases during 1990- 1997 were retrospectively studied. 7 cases underwent sungical treatment anteriorly or posteriorly both. Results: Varying degrees of fever, spasmodic pain and rise in ESR wer the typical characteristics. The early pathological changes could be found by MRI(1 week),CT(3 weeks) and plain X - ray film(5 weeks) after onset. Surgical intervention reduced the total dosage of systemic antibiotics and anodynes, also shortened the patient's hospitalized day and clinical course. Conclusion: ESR and MRI are very useful in diagnosis and therapy. When high fever, severe spasm pain and sustained rise in ESR are beyond control with conervative heatment, decompression and intervertebral bone fusing' are indicated.