无发热胸椎段硬脊膜外脓肿临床诊断学特征并文献复习  被引量:2

Diagnosis features of thoracic spinal epidural abscess without fever and review of literature

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作  者:马龙飞 章旭[2] 孔祥清[2] 王叶新[2] 孟纯阳[2] 

机构地区:[1]济宁医学院,在读研究生272067 [2]济宁医学院附属医院脊柱外科,272029

出  处:《中华诊断学电子杂志》2017年第4期253-256,共4页Chinese Journal of Diagnostics(Electronic Edition)

基  金:国家自然科学基金(81572205)

摘  要:目的探讨硬脊膜外脓肿(SEA)的临床诊断学特征。方法回顾分析1例SEA不伴发热患者的临床资料,并复习文献。结果患者为老年男性,于2016年6月22日22时因腰背部疼痛及双下肢活动受限在济宁医学院附属医院脊柱外科就诊。患者2型糖尿病病史3余年,未曾服药控制血糖。入院时体温36.8℃,血糖8.2 mmol/L,白细胞计数10.80×10~9/L,C-反应蛋白82 mg/L和中性粒细胞百分比83.60%。术前磁共振(MRI)平扫结果:T7-11节段椎管内脊髓后方异常高信号;急诊行"椎管减压术",术中见椎管内白色黏稠脓液,并取脓液送细菌培养;术后细菌培养结果为金黄色葡萄球菌,术后19 d MRI平扫结果:脊髓压迫已解除,脊髓后未见异常信号;术后10个月随访,患者双下肢活动正常。结论 SEA是一种少见病,其早期诊断具有一定困难,其中SEA不伴发热的诊断更为困难,需要结合临床医生经验、患者临床表现、实验室检查、影像学检查等,方可做出正确诊断。糖尿病患者是SEA的高发人群,当该类人群出现腰背痛和炎症指标升高时,尽管没有发热,也应怀疑SEA的发生,并进一步行MRI明确诊断。Objective To explore the diagnosis features of spinal epidural abscess ( SEA).Methods The clinical data of 1 case of SEA without fever was analyzed retrospectively. Literatures werereviewed and features of clinical diagnosis of SEA were summarized.Results The patient was an old man,and was admitted to department of spine surgery of Affiliated Hospital of Jining Medical University for lowback pain and paralysis of lower limbs.He had a history of diabetes mellitus for more than 3 years withouttaking medicine to control his blood sugar. On admission, his body temperature was 36. 8℃, blood sugar8.2 mmol / L,initial white-cell count 10. 80 × 109/ L ( 83. 60% neutrophils), and serum C-reactive protein82 mg / L.MRI revealed abnormal high signal in T7-11 segment of intraspinal epidural space at admission.Decompressive laminectomy was performed urgently.During the operation,the white viscous pus in the spinalcanal was observed and the pus was taken for bacterial culture.The result of bacterial culture was Staphylococcusaureus.Postoperative MRI scan which performed on the nineteenth day after surgery revealed the spine hasbeen decompressed successfully. After 10 months follow-up, the lower limbs recovered. ConclusionsClinically,SEA is an uncommon disorder,and the early diagnosis of SEA is difficult,especially SEA withoutfever.The accurate diagnosis needs a combination of clinician experience,clinical manifestation in patients,laboratory examination and imaging assays. Patients with diabetes mellitus are the highest risk subgroup ofSEA.When the diabetic patients with low back pain and the increase of inflammatory markers,spinal epiduralabscess should be considered,although patient′ s body temperature is normal. And further,MRI should becarried out to clarify the diagnosis.

关 键 词:硬脊膜外脓肿 金黄色葡萄球菌 发热 诊断 

分 类 号:R687.3[医药卫生—骨科学]

 

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