79-颈椎硬膜外脓肿3例诊治分析三院卢斌

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1、颈椎硬膜外脓肿诊治分析卢斌，罗科锋，蒋国强，陆继业，岳兵，史超路作者单位：315010宁波，宁波大学附属医院通信作者：卢斌，Email：lubin@medmail.com.cn【摘要】目的探讨颈椎硬膜外脓肿的临床特点和治疗方法，以提高检出率和疗效。方法回顾性分析3例颈椎管内硬膜外脓肿患者的临床资料，观察记录其治疗前、治疗后四周、1年及2年的疼痛视觉评分(VAS),日本矫形外科学会评分法(JOA)评估患者神经功能情况，血指标化验、血培养及脓液培养检测其致病菌。结果手术均取得成功，其中2例患者行颈前路椎间盘切除减压融合术加脓肿清除，另外1例行保守治疗。术后患者VAS评分较

2、术前均增加，血沉和血白细胞及中性粒细胞比率较术前明显好转，血培养及脓液培养结果均为金黄色葡萄球菌。结论硬膜外脓肿常见致病菌是金黄色葡萄球菌，应及时釆取手术治疗以防止神经功能恶化。【关键词】硬膜外脓肿；颈椎；疼痛中图分类号：R687.3AnalysisofthediagnosisandtreatmentforcervicalspinalepiduralabscessLuBin,Luokefeng,Jiangguoqiang,etal.DepartmentofOrthopaedicSurgery,theaffiliatedhospitalofNingboUniversit

3、y,medicalschool,Ningbo315020[Abstract】objective:Spinalepiduralabscess(SEA)ofcervicalspineisarareinfectiousdisorder,oftenwithadelayeddiagnosis,andassociatedwithsignificantmorbidityandmortalityrates.Weconductedaretrospectivestudytodefineitsclinicalcharactetistics、treatmentandtoimprovetheo

4、utcomeofSEA.Methods:Themedicalchartsof3menwithcervicalSEAovera11-yearperiod(from2000-2011)werereviewedandanalyzed.Result:2caseshadunderlyingdiseasesofdiabctcs,1hadinitialinfectionwithhisfinger.Localizedcervicalseverepain(VAS8-9),neuraldeficitwerethecommonmanifestation.Theerythrocytesedi

5、mentationrate(ESR)andwhitebloodcellwereabnormallyhigh,aswel1astherateofneutrophil.StaphylococcusaureuswasthecauseofSEAisolatedfromblood(1case)andpus(2cases)•2caseshadoperationsofanteriorcervicaldiskectomyandfusionafterpuswascleaned,theothercasewasacceptedwithconservationtreatment.Allhad

6、agoodresultwhenfollow-up・Conclusions:SevereneckpainwithoutinjuryinadiabetespatientwithsignificantriskforSEAwarrantsanimmedieitemagneticresonanceimagingexaminationandneuralphysicalcheckfrequently.StaphylococcusaureuswasthemostcommoncauseofSEA.Surgicaltreatmentcanisolatethecausativeorgani

7、smanddecompressthecordincasesofneurologicaldeteriorationorseverepain.Keywords:Spinalepiduralabscess;Cervicalspine;Pain近年来硬膜外脓肿(SEA)发病率不断升高，可能与社会老龄化、静脉吸毒、脊柱内固定及椎管内外操作等相关。自发性SEA早期表现为剧烈颈痛，很容易被误诊，病情发展迅速，易发展为瘫痪甚至死亡。笔者回顾性分析3例硬膜外脓肿患者的临床资料，分析其发病特点、症状及治疗情况，现报道如下。1资料与方法1.1一般资料收集2000年6月至2