北京大学学报(医学版) ›› 2020, Vol. 52 ›› Issue (2): 275-280. doi: 10.19723/j.issn.1671-167X.2020.02.013
Chang-cheng MA,Zhen-yu WANG(),Guo-zhong LIN
摘要:
目的 总结原发性椎管内脓肿的特点以及治疗方法,以期提高原发性椎管内脓肿的诊断与治疗水平.方法: 回顾性分析北京大学第三医院近20年来收治的13例原发性椎管内脓肿的病例,分别对其病史,病因,病原学,手术方式以及预后进行分析.结果: 所有病例病程从7 d到6个月不等,所有病例均以疼痛起病,有10例自觉肢体无力,有5例患者有发热史,8例血常规白细胞升高.13例中颈椎管内脓肿1例,颈胸段1例,胸段1例,胸腰段4例,腰骶段6例.病原学中,细菌培养阳性4例,病理学诊断结核3例,1例因发病前感染布氏杆菌(Brucella)按该细菌感染治疗,其余病例病原学结果均阴性.所有病例均行手术治疗,并获得组织病理学诊断.手术目的主要为清除病灶并减压,引流.术后根据病原学结果及临床经验予以抗感染及激素治疗.有2例术后形成切口脓肿再次行手术治疗,手术为清创及转移肌瓣修复.随访0.5~3.0年,平均1.8年.随访期1例术后复发并沿椎管扩散,再次手术治疗.所有病例最后炎症均完全恢复,神经系统体征较术前均有不同程度好转.结论: 原发性椎管内脓肿发病相对较急,主要以疼痛起病,腰骶部最好发,细菌培养多以阴性为主.建议早期手术,使用广谱,足量抗生素.术后如出现切口脓肿形成,宜在清创基础上转移肌瓣修复.术后为缓解脊髓和神经根水肿,可在抗生素保障下使用激素.
中图分类号:
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