颈胸段脊椎放线菌感染伴脊髓压迫症  

Cervical thoracic actinomycosis with spinal cord compression

作　　者：王珏[1] 杜倬婴[1] 张培蕾[1] 李明华[1] 徐世定[1] 

机构地区：[1]上海交通大学附属第六人民医院介入病房,200233

出　　处：《疑难病杂志》2007年第2期82-84,共3页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨脊椎放线菌感染的临床和影像学特点及治疗方法。方法回顾性分析3例经病理证实的颈胸段脊椎放线菌病患者的临床、影像学特点及诊治方法。结果3例患者临床均表现为明显的脊髓压迫症状,无明显感染证据。3例MRI均显示颈胸段病变,椎体骨质破坏,硬膜外软组织肿块伴脊髓压迫。组织病理学检查证实3例均为放线菌感染,其中2例表现为炎性肉芽组织伴微脓肿形成,1例表现为硬膜外脓肿。术后随访,3例患者临床症状及影像学表现均得到明显改善。结论脊椎放线菌感染临床和影像学表现无特征性,其确诊依赖于病理学和微生物学检查。联合脓肿清除、椎管内减压术和大剂量抗生素治疗对伴有脊髓压迫症的患者有效。Objective To investigative the clinic symptoms, radiological characters and clinical treatment of actinomycosis accompanied with cervical thoracic spinal cord compression.Methods Three patients identified by histopathology were included in the study. Their clinical symptoms, radiological finds, methods of treatment were analyzed retrospectively. Results All the three patients presented the symptoms of spinal cord compression clinically, but there was no evidence to support infection. According to MRI, all the patients revealed destruction of vertebral body, extradural soft tissue mass and spinal cord compression. Histopathology showed the infection of actinomycete, and intradural abscess could be seen in one case, while granulomatous inflammation could be seen in the other two cases. Vertebral canal decompression was performed, high-dose penicillin G intravenous injection after operation for 4 - 8 weeks was administrated, oral application for 4 - 6 months was maintained. Follow-up showed significant changes both in clinical symptoms and in radiology. Conclusion Radiological and clinical finds of spinal actinomycosis are not specific, so the diagnosis depends on histopathological and biological examination. Decompression surgery combined with high-dose of penicillin G can obtain better therapeutic effect.

关 键 词：感染 放线菌 脊椎 脊髓压迫症 

分 类 号：R519[医药卫生—内科学] R744[医药卫生—临床医学]