兔椎间盘炎的抗生素预防与介入治疗的影像学表现  

The antibiotic prevention and interventional treatment as well as medical imaging manifestations of rabbit discitis

作　　者：孙钢[1] 袁成[1] 黄德清[1] 董政军[1] 

机构地区：[1]济南军区总医院,济南250031

出　　处：《中华放射学杂志》1999年第11期780-783,共4页Chinese Journal of Radiology

摘　　要：目的　探讨椎间盘炎的抗生素预防与介入治疗及其影像学表现。方法　用２４ 只新西兰兔制作椎间盘炎动物模型，并随机分为４ 组，即非治疗组、抗生素预防组、抗生素治疗组、介入治疗组。抗生素预防组在椎间盘炎发生前静脉滴注克林霉素３ 天；抗生素治疗组在椎间盘炎发生１ 周后静脉给药４ 周；介入治疗组在椎间盘炎发生１ 周后用经皮椎间盘切除术（ＰＬＤ） 的方法切除部分椎间盘组织，同时静脉给药１ 周。实验动物在椎间盘组织注入细菌后２ 周与４ 周，分别行常规Ｘ 线、ＣＴ及ＭＲＩ检查。６ 周后处死动物，实验区脊柱标本送病理学检查，并作细菌培养。结果　非治疗组与抗生素治疗组的实验区椎间盘均呈椎间盘炎影像学表现，椎间隙变窄，椎体骨质破坏及增生，尸解显示间盘组织坏死糜烂，椎体边缘骨质破坏；细菌培养多为阳性。介入治疗组，影像学表现为椎间隙变窄，显示髓核组织被纤维组织取代，细菌培养阴性。抗生素预防组，无椎间盘炎发生。结论　ＭＲＩ是发现椎间盘炎的较敏感方法；抗生素预防用药是防止椎间盘炎发生的关键措施；介入治疗可有效阻止椎间盘炎的病理进程；而一旦椎间盘炎发生，单纯静脉给予抗生素不能阻止其病理进程。Objective To assess the role of antibiotic and interventional radiology in prevention and treatment of discitis and analyze the imaging manifestations of discitis Methods 24 rabbits were used to make discitis models, and were classified into 4 groups randomly,6 casesper group: non treatment group, prophylactic antibiotic group, therapeutic antibiotic group and interventional treatment group In prophylactic antibiotics group, intravenous clindamycin was administered 3 days before inoculation of bacteria to disc In therapeutic antibiotics group, 4 week course of intravenous antibiotics was commenced 1 week after the bacterial inoculation In interventional treatment group, PLD were performed 1 week after the inoculation, with simultaneous intravenous antibiotics for a period of 1 week, 2 or 4 weeks after inoculation The lumbar spines of all rabbits were examined by X ray, CT, and MRI respectively Needle biopsy of nuclear pulpous was obtained and experimental region of lumbar spine were removed for pathological examination Results In non treatment group and therapeutic antibiotics group, all of the discs inoculated with bacteria developed radiographic and pathological evidence of discitis, including intervertebral space narrowing, inflammatory changes of disc tissue, and destruction of end plates In prophylactic antibiotics group, none of the discs developed radiographic and pathological evidences of discitis, the bacterial culture was negative In interventional treatment group, disc narrowing was observed in medical image and fibrosis was found in nucleus region There was no evidence of destruction of end plate, the bacteria culture was negative Conclusion MRI is a relative sensitive method to detect discitis Prophylactic antibiotics is a key measure to prevent discitis The PLD treatment could hold back the pathological process of discitis Once developed, intravenous antibiotic is unable to affect the course of discitis

关 键 词：椎间盘炎 预防 介入放射学 治疗 CT 抗生素 

分 类 号：R681.53[医药卫生—骨科学] R816.8[医药卫生—外科学]