术后椎间盘炎的抗生素预防和介入治疗及影像学表现

目的提高对术后椎间盘炎临床与影像学表现的认识，探讨其预防及介入治疗方案。材料与方法对35例椎间盘炎的病理、临床、影像学表现及介入治疗方案进行分析。460例实施经皮椎间盘切除术(PLD)技术或外科手术治疗腰椎间盘突出症的患者进行抗生素预防性用药。结果病理学检查示椎间盘组织中有中性粒细胞和淋巴细胞浸润；影像学表现主要有椎间隙变窄、椎体局限性骨质破坏及终板增生与硬化；腰背部剧烈疼痛伴血沉增快是主要临床表现；主要病原菌为金黄色葡萄球菌、表皮葡萄球菌、大肠杆菌等。克林霉素的静脉给药可渗人人体椎间盘内，手术前后用此类抗生素能阻止椎间盘炎的发生；PLD技术可缓解症状，缩短病程。结论手术前后应用可进入椎间盘内的抗生素是预防该病的有效方法；充分认识该病的临床与影像学表现，有助于该病的早期诊断；PLD技术治疗该病效果好。

The antibiotic prevention and interventional therapy as well as medical imaging manifestation of pastoperative disctitis

Purposes To improve the recognization of the clinic and imaging finding of postoperative disctitis,to study the method on prevention and interventional therapy of the disease. Materials and methods It was analed that the pathologic,clinical, imaging finding and theraputic plan of the disease in 35 cases. It was observed that the effect of prophylactic antibiotics in 460 with intervertebral disc operation of PLD. Results The pathologic finding was that infiltrition of the neutrophil and lymphocyte in the intervetebral disc. The main pathogens were Staphylococcus aureus, Staphylococcus epidermidis and Bacillus coli. The main fea tures of imaping were presented as: narrowed intervertebral space, local destroy of vertebrae, erosion and Sclerosis of bony end - plated. Severe pain of lumbar back companied with rise of ESR was the important sign of clinic. Clindamycin,was one of the antibiotics which could penetrate into the nucleus pulposus via vein. PLD could relief the symptoms and decrease the course of the disease Conclusion It could prevent effectively the postoperative disctitis that above antibiotics were given preoperation and postoperation. It is benifited to fully recognized the clinical and imaging features of disctitis for early diagnosing the disease. The theraputic effect of PLD was effec effective for the disease.