脊柱放线菌感染并发脊髓压迫症(附3例报告)  

Vertebral column actinomycotic infection complicated with spinal cord compression:report of three cases

作　　者：王珏[1] 杜倬婴[1] 张培蕾[1] 

机构地区：[1]上海交通大学附属第六人民医院介入影像科,200233

出　　处：《临床神经病学杂志》2007年第2期145-147,共3页Journal of Clinical Neurology

摘　　要：目的探讨脊柱放线菌感染并发脊髓压迫症的临床和影像学特点及治疗方法。方法回顾性分析3例经病理检查证实的本病患者的临床资料。结果3例患者均有颈、胸脊椎及软组织感染和脊髓压迫症状;MRI示病变椎体骨质破坏,颈、胸硬膜外软组织肿块,脊髓受压。病理学检查组织病理学检查证实3例均为放线菌感染,2例表现为炎性肉芽组织伴微脓肿形成,另1例表现为硬膜外脓肿。均予以脓肿清除、脊髓减压术,并给予4~8周大剂量青霉素G静脉滴注,后改口服维持4~6个月,术后及随访3例患者均取得显著的疗效。结论脊柱放线菌感染并发脊髓压迫症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。脓肿引流、椎管内减压术和大剂量抗生素治疗有效。Objective To investigate the clinical, radiological features and therapy of spinal actinomycotic infection complicated with spinal cord compression. Methods The data of three patients confirmed by histopathology were analyzed retrospectively. Results All three patients presented with infection of cervical thoracal vertebral bodies and soft tissue, and with syndrome of spinal cord compression. MRI examination revealed destruction of vertebral bodies, extradural soft tissue mass and spinal cord compression. Histopathological examination confirmed the infection of aetinomycete in all three patients. Granulomatous inflammation could be seen in two cases, while extradural abscess was found in the other one case. Three patients all received the operation of abscess draining and vertebral canal decompression. Large-dose of Penicillin G following operation was administrated intravenously for 4 -8 weeks, and then changed to oral application for another 4 - 6 months. Follow-up showed significant clinical effect in these three patients. Conclusions Radiologic and clinical findings of spinal actinomycotic infection complicated with spinal cord compression are nonspecific, and the diagnosis of this disease depends on pathological and microbiologic exams. Treatments with abscess draining, vertebral canal decompression and large-dose of antibiotic may achieve good clinical outcome.

关 键 词：放线菌 脊柱 脊髓压迫症 感染 MRI 

分 类 号：R519[医药卫生—内科学]