椎间盘炎的诊断和治疗  

Diagnosis and treatment of lumbar discitis

作　　者：刘红军[1] 李会齐[1] 

机构地区：[1]河南省洛阳市中心医院,河南洛阳471009

出　　处：《中医临床研究》2010年第21期66-68,共3页Clinical Journal Of Chinese Medicine

摘　　要：目的：分析椎间盘炎病人的分类、临床表现及各种治疗措施的优缺点，为进一步提高该病的诊断率、治疗效果提供参考。方法：对1983年1月～2003年1月我院收治的椎间盘炎病人156例（男性89例，女性67例，平均年龄45．74岁）进行回顾性研究，其中原发性椎间盘炎5例，继发性151例，腰椎间盘常规手术后97例，腰椎间盘穿刺胶原酶溶核术后31例，经皮腰椎间盘穿刺抽吸术后19例，腰椎间盘穿刺造影检查2例，椎间盘镜下髓核摘除术后2例。病人表现为剧烈的腰背痛，腰部活动受限。早期血沉、C反应蛋白升高，2周后影像学表现为椎间隙的破坏、变窄，椎体终板早期溶骨性、后期增生性改变，周围软组织肿胀等。处理方法主要包括保守治疗（制动、消炎），病灶冲洗、腰椎脊神经后支选择性切断及术后腰椎内固定等。结果：保守治疗4～6个月，手术治疗1～3个月，病人腰腿痛症状缓解。各种治疗措施对病人的症状持续时间、住院时间及残余症状等方面存在差异。但病人的最终转归是相邻椎体的骨性融合。结论：椎间盘炎应早诊断、早治疗，腰椎后路病灶清除及内固定手术是治疗该病的最有效、最经济手段。Objectives： To analyze the types, clinical symptoms and different therapies of lumbar discitis. And to improve the rate of diagnosis and treatment about this disease. Methods： 156 patients have been treated in our hospital because of discitis from January 1983 to January 2003, （which include 89 males and 67 females, and the average age was 45.74）. There are different types of discitis, including 5 cases of primary disc space infection and 151 cases of secondary infection after operation 97 cases because of discectomy, 31 cases of percutaneous lumbar chemonucleolysis, 19 cases of percutaneous lumbar discectomy, 2 cases of discography and 2 cases of laparoscopic lumbar discectomy. The main symptom are severely pain and limited movement in low lumbar. And the laboratory studies includes high erythrocyte sedimentation rate （ESR）, unnormal C-reactive protein which may be sensitive to present infection and effectiveness of treatm -ent＇response. Different signs such as low disk intensity and disk height, endplate erosion and calcification, paraspinal edema may be seen 2 weeks late by imaging studies of magnetic resonance imaging, computed tomography and plain radiographs. The patients were treated by conservative methods including long-term bed rest and antituberculous therapy or by operative intervention including debridement, spinal immobilization, selective cut of lumbar posterior rani and reconstruction. Results： Pain was relieved 4-6 months after conservative therapy and 1-3 months after operation methods. There have difference in pain-lasting time, hospital stay and residual symptom. All patients had bone fusion result in vertebral body connect to infect disc. Conclusion： Discitis should be early diagnosis and early treatment, treating discitis with selective cut of lumbar posterior rani and spinal immobilization is the most economic means.

关 键 词：椎间盘炎 再手术 腰椎 治疗 

分 类 号：R274.34[医药卫生—中医骨伤科学]