腰椎间隙感染肺炎克雷伯菌合并阴沟肠杆菌的诊疗  

Diagnosis an d Treatment of Klebsiella Pneumoniae Combined with Enterobacter Cloacae in Lumbar Intervertebral Space Infection

作　　者：程翰文 吴朝娟 刘卓劼 吴昊宇 张笛 王宁 李春海[1,3] CHENG Han-wen;WU Zhao-juan;LIU Zhuo-jie;WU Hao-yu;ZHANG Di;WANG Ning;LI Chun-hai(Department of Orthopedic Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China;School of Clinical Medicine,Southwest Medical University,Luzhou 646000,China;Department of Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院骨外科,广东广州510120 [2]西南医科大学临床医学院,四川泸州646000 [3]中山大学孙逸仙纪念医院外科教研室,广东广州510120

出　　处：《中山大学学报（医学科学版）》2023年第3期485-489,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广州市科技计划项目(202102010259)。

摘　　要：【目的】罕见的原发性腰椎间隙感染肺炎克雷伯菌合并阴沟肠杆菌的临床诊疗初探,为此类罕见脊柱感染诊疗提供临床经验。【方法】腰痛伴左下肢麻痛7月余、加重1周余的老年男性患者,经实验室、影像学检查,诊断为腰椎间盘突出症,入院后症状急性加重,复查腰椎增强MRI示L3/4椎间隙后部局部强化信号,VAS评分9分,腰部JOA评分6分。实施腰椎后路L3/4、L4/5椎间盘摘除+cage植骨融合+L3-L5椎弓根钉棒内固定术,并留取术中L3/4椎间盘标本备细菌培养。【结果】细菌培养结果回示肺炎克雷伯杆菌及阴沟肠杆菌感染,术后敏感抗生素治疗6周,患者在术后半年的随访中获得痊愈。【结论】对临床表现为急性剧烈腰痛或下肢疼痛的中老年患者,在常规实验室、影像学检查提示腰椎退行性疾病的同时应考虑脊柱感染可能。【Objective】To explore the clinical diagnosis and treatment of rare primary lumbar intervertebral space infection with Klebsiella pneumoniae and Enterobacter cloacae,and provide clinical experience for the diagnosis and treatment of this rare spinal infection.【Methods】An elderly male patient with low back pain and numbness in the left lower extremity for more than 7 months,which aggravated for more than 1 week,was diagnosed with lumbar disc herniation after laboratory and imaging examinations.After admission,the symptoms became acutely aggravated,and re-examination of lumbar enhanced MRI showed local enhancement at the posterior edge of the L3/4 intervertebral space.The VAS score was 9 points,and the lumbar JOA score was 6 points.A posterior lumbar interbody fusion of L3-L5 was performed,and L3/4 intervertebral disc specimens were collected during the operation for bacterial culture.【Results】Bacterial culture results showed Klebsiella pneumoniae and Enterobacter cloacae infection.The patient was treated with sensitive antibiotics for 6 weeks after the operation,and the patient was cured during the follow-up of half a year after the operation.【Conclusion】For middle-aged and elderly patients with clinical manifestations of acute severe low back pain or lower extremity pain,the possibility of spinal infection should be considered when routine laboratory and imaging examinations suggest lumbar degenerative diseases.

关 键 词：腰椎间隙感染 肺炎克雷伯菌 阴沟肠杆菌 鉴别诊断 

分 类 号：R681.5[医药卫生—骨科学] R378[医药卫生—外科学]