Pyogenic vertebral osteomyelitis
Pyogenic vertebral osteomyelitis
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DOI：
10.2106/00004623-199706000-00011
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发表时间：
1997-06-01
影响因子：
5.3
通讯作者：
Carragee, EJ
中科院分区：
文献类型：
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作者：
Carragee, EJ
我回顾了111例与脊柱开放手术无关的化脓性椎体骨髓炎患者的记录。确诊时的平均年龄为60岁(范围从18岁到84岁)；61名患者(55%)年龄在60岁或以上。44名患者(40%)继发于糖尿病、使用皮质类固醇、癌症化疗、风湿性或免疫性疾病、肾功能衰竭或肝功能衰竭、营养不良或骨髓发育不良，继发免疫系统受损。103名患者(93%)接受了磁共振成像，这对确定早期诊断至关重要。68名患者(61%)是在症状出现后一个月内诊断出感染的。最常见的感染微生物是金黄色葡萄球菌(40例；36%)。41名患者(37%)的感染是由生物引起的，如表皮葡萄球菌、痤疮丙酸杆菌和类白喉，这些生物传统上被认为是低毒性的。尿路是最常见的感染源(确诊患者13例，疑似患者21例)。非手术治疗的成功取决于四个独立变量：年龄不到60岁、免疫状况、金黄色葡萄球菌感染和红细胞沉降率下降。对42例患者行清创关节融合术。其中14名患者还在有感染的情况下接受了脊柱内固定，而不影响结果。最后一次随访时死亡18例，平均4年(2年2个月~6年6个月)：7例非手术治疗的患者在确诊后1个月内死亡，3例在急性期死亡，3例死于截瘫晚期并发症，5例死于原因不明。在术后至少两年接受检查的89名患者中，没有一名患者晚期感染复发。只有7名患者观察到慢性严重的背部疼痛。
I retrospectively reviewed the records of 111 patients who had pyogenic vertebral osteomyelitis unrelated to an open procedure on the spine. The mean age at the time of the diagnosis was sixty years (range, eighteen to eighty-four years); sixty-one patients (55 per cent) were sixty years old or more. Forty-four patients (40 per cent) had an impaired immune system secondary to diabetes mellitus, the use of corticosteroids, chemotherapy for cancer, rheumatic or immunological disease, renal or hepatic failure, malnutrition, or myelodysplasia. Magnetic resonance imaging, critical for the determination of an early diagnosis, was performed for 103 patients (93 per cent). The infection in sixty-eight patients (61 per cent) was diagnosed within one month after the onset of symptoms. The most frequent infecting organism was Staphylococcus aureus (forty patients; 36 per cent). The infection in forty-one patients (37 per cent) was caused by organisms, such as Staphylococcus epidermidis, Propionibacterium acnes, and diphtheroid species, that are traditionally considered to be of low virulence. The urinary tract was the most frequent source of infection (confirmed in thirteen patients and suspected in twenty-one).The success of non-operative treatment was predicted by four independent variables: an age of less than sixty years, the immune status, infection with Staphylococcus aureus, and a decreasing erythrocyte sedimentation rate. Forty-two patients were managed with debridement and arthrodesis. Fourteen of these patients also had instrumentation of the spine, in the presence of infection, without compromise of the outcome. Eighteen patients died by the time of the latest follow-up evaluation at a mean of four years (range, two years and two months to six years and six months): seven who had been managed non-operatively died in the first month after the diagnosis was made, three died in the acute postoperative period, three died of late complications of paraplegia, and five died of unrelated causes. None of the eighty-nine patients who were seen at a minimum of two years postoperatively had had late recurrence of infection. Chronic, severe back pain was noted in only seven patients.