| 化脓性脊柱炎20例的临床特点分析 |
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Received:April 27, 2016
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| 作者 | Author | 单位 | Unit | E-Mail |
| 张顺聪 |
ZHANG Shun-cong |
广州中医药大学, 广东 广州 510405
广州中医药大学第一附属医院, 广东 广州 510407 |
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| 李永贤 |
LI Yong-xian |
广州中医药大学, 广东 广州 510405 |
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| 莫凌 |
MO Ling |
广州中医药大学第一附属医院, 广东 广州 510407 |
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| 粱德 |
LIANG De |
广州中医药大学第一附属医院, 广东 广州 510407 |
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| 杨志东 |
YANG Zhi-dong |
广州中医药大学第一附属医院, 广东 广州 510407 |
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| 郭丹青 |
GUO Dan-qing |
广州中医药大学第一附属医院, 广东 广州 510407 |
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| 冯蓬勃 |
FENG Peng-bo |
广州中医药大学, 广东 广州 510405 |
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| 莫国业 |
MO Guo-ye |
广州中医药大学, 广东 广州 510405 |
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| 李大星 |
LI Da-xing |
广州中医药大学, 广东 广州 510405 |
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| 李永巍 |
LI Yong-wei |
广州中医药大学, 广东 广州 510405 |
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| 唐永超 |
TANG Yong-chao |
广州中医药大学第一附属医院, 广东 广州 510407 |
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xijing_h@vip.tom.com |
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| 期刊信息：《中国骨伤》2016年29卷，第10期，第923-927页 |
| DOI：10.3969/j.issn.1003-0034.2016.10.010 |
| 基金项目:广东省科技厅项目（编号：2012B031800208）；广东省自然基金项目（编号：S2013010015870） |
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目的：探讨综合患者临床表现、实验室检查及影像学变化对化脓性脊柱炎进行诊断的价值，总结化脓性脊柱炎患者的临床特点。
方法：回顾性分析2012年3月至2015年3月经组织病理学确诊的20例化脓性脊柱炎患者临床资料，男9例，女11例；年龄43~72岁，平均58.9岁。颈椎3例，胸椎7例，腰椎10例。分析患者在接受治疗前的临床症状，体征，实验室检查[包括血液分析、红细胞沉降率（ESR）和C-反应蛋白（CRP）]，影像学检查（包括X线片、CT及MRI），应用疼痛视觉模拟评分（VAS）记录患者治疗前局部疼痛情况。
结果：治疗前所有患者有患椎处疼痛，VAS 9分4例，8分6例，7分1例，3分6例，2分3例。其中7例伴有神经症状，11例伴有夜间疼痛加剧，10例伴有发热。白细胞、中性粒细胞计数升高5例，正常15例；CRP升高19例，正常1例；20例患者ESR均升高。X线片显示椎间隙均变窄，13例伴有椎体的骨质破坏；CT显示20例患者有病变椎体骨质破坏、硬化。MRI检查显示病变椎体在T1像上表现为不均匀中等偏低信号，在T2像上16例呈不均匀高信号，2例呈均匀高信号，2例呈高信号为主的混杂信号。13例患者进行了手术治疗，7例患者接受了保守治疗，治疗后患者VAS评分明显改善后出院。
结论：化脓性脊柱炎容易误诊漏诊，在早期诊断中应综合分析患者临床表现、实验室检查及影像学表现特点，为下一步诊疗方案提供依据。 |
| [关键词]:化脓性脊柱炎 体征和症状 诊断,化验室 体层摄影术,X线计算机 磁共振成像 |
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| Analysis of clinical characteristics of 20 patients with pyogenic spondylitis |
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Abstract:
Objective:To investigate the diagnostic value of clinical manifestation,laboratory examination and imaging changes for pyogenic spondylitis and to summarize the clinical characteristics of patients with pyogenic spondylitis.
Methods:The clinical data,of 20 patients with pyogenic spondylitis were diagnosed by histopathological examination from March 2012 to March 2015,were retrospectively analyzed. There were 9 males and 11 females,aged from 43 to 72 years old with an average of 58.9 years. Included 3 cases of cervical vertebrae,7 cases of thoracic vertebrae,10 cases of lumbar vertebrae. Patients of blood analysis,erythrocyte sedimentation rate(ESR),C reactive protein(CRP),X-rays,CT and MRI were performed before treatment. Visual analogue scale (VAS) was used to evaluate the pain of patients suffering from vertebral pain.
Results:All the patients had suffered from vertebral pain before treatment. VAS was 9 points in 4 cases,8 points in 6 cases,7 points in 1 case,3 points in 6 cases,and 2 points in 3 cases. Among them,7 patients complicated with neurological symptoms,11 with aggravating night pain,10 with fever. WBC and Neutrophil count (NEU) of 5 cases were increased and other 15 cases were normal;CRP of 19 cases were increased and 1 case was normal;ESR of all 20 cases were increased. X-rays showed the intervertebral space narrowing in all 20 cases,13 cases complicated with destruction of vertebral body;CT showed the lesions of vertebral body in the 20 cases and complicated with destruction,sclerosis of sclerotin;MRI showed that the lesions of the vertebral body in the T1 image had uneven medium low signal,in the T2 image of the 16 cases had uneven high signal and 2 cases had uniform and high signal,2 cases had main high signal compliated with mixed signal. Thirteen patients underwent surgical treatment and 7 patients received conservative treatment,and the patients left hospital while VAS had significantly improved after treatment.
Conclusion:Pyogenic spondylitis is easy to be misdiagnosed or missed in clinic. It can be combined with the clinical manifestations,laboratory examination and imaging characteristics in order to make a definite diagnosis for purulent spondylitis in early. |
| KEYWORDS:Pyogenic spondylitis Signs and symptoms Diagnosis,laboratory Tomography,X-ray computed Magnetic resonance imaging |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张顺聪,李永贤,莫凌,粱德,杨志东,郭丹青,冯蓬勃,莫国业,李大星,李永巍,唐永超.化脓性脊柱炎20例的临床特点分析[J].中国骨伤,2016,29(10):923~927 |
| 英文格式: | ZHANG Shun-cong,LI Yong-xian,MO Ling,LIANG De,YANG Zhi-dong,GUO Dan-qing,FENG Peng-bo,MO Guo-ye,LI Da-xing,LI Yong-wei,TANG Yong-chao.Analysis of clinical characteristics of 20 patients with pyogenic spondylitis[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(10):923~927 |
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