摘要
目的探讨原发性非特异性脊柱感染与脊柱结核的临床特征。方法回顾性分析2014年1月至2015年12月河北省胸科医院骨科收治的197例脊柱感染性疾病患者。按照病原菌种类分为原发非特异性感染组[非特异性感染组,21例(10.7%)]和结核组[176例(89.3%)]。比较两组患者的临床资料、实验室指标和影像学表现,并总结非特异性感染组患者的病原学检测及治疗转归情况。结果非特异性感染组的年龄[62.0(49.5,66.5)岁]、平均发热体温峰值[(38.8±0.9)℃]、入院时白细胞计数[8.4(6.9,9.4)×10^(9)/L]、血红细胞沉降率[76.0(61.5,103.5)mm/1h]及C反应蛋白[68.0(56.9,79.0)mg/L]均明显高于结核组[分别为38.5(24.0,54.5)岁、(37.8±0.6)℃、6.5(5.2,7.4)×10^(9)/L、40.0(30.0,50.0)mm/1h、24.0(18.0,28.0)mg/L],差异均有统计学意义(U=914.000,P=0.000;t=4.320,P=0.000;U=1005.000,P=0.001;U=307.500,P=0.000;U=100.000,P=0.000),但起病时间[1.5(1.0,2.0)个月]短于结核组[6.0(4.0,7.8)个月],差异有统计学意义(U=120.000,P=0.000);胸部X线摄影显示骨桥形成[38.1%(8/21)]、CT显示死骨[38.1%(8/21)]及椎旁脓肿[19.0%(4/21)]的发生率与结核组[分别为9.7%(17/176)、72.2%(127/176)、52.3%(92/176)]的差异均有统计学意义(χ^(2)=11.246、10.094、8.290,P=0.000、0.001、0.004)。非特异性感染组有4例术后不愈,分别经调整抗生素及行病灶清除术联合置管冲洗引流治疗后治愈,随访期间无复发。结论原发非特异性感染患者较脊柱结核患者有较高的年龄、体温、白细胞计数、血红细胞沉降率、C反应蛋白,但病程较短,且较易形成骨桥和死骨,经手术和药物治疗后可完全治愈且无复发。
Objective To analyze the clinical characteristics of the patients with primary non-specific spinal infection and spinal tuberculosis(TB).Methods A retrospective analysis was conducted in 197 patients with spinal infectious diseases who were admitted in the Department of Orthopedics of Hebei Provincial Chest Hospital from January 2014 to December 2015.According to the type of pathogenic bacteria,those enrolled patients were divided into two groups:one was the primary non-specific spinal infection group(non-specific infection group,21 cases(10.7%))and the other was spinal TB group(TB group,176 cases(89.3%)).The clinical materials,laboratory examination results and imaging manifestations of the patients in the two groups were compared,and the results of pathogeny detection and treatment outcome of the patients in the non-specific infection group were summarized.Results The age(62.0(49.5,66.5)years),mean peak value of body temperature in fever((38.8±0.9)℃),white blood cells(WBC)count(8.4(6.9,9.4)×10^(9)/L),erythrocyte sedimentation rate(ESR)(76.0(61.5,103.5)mm/1 h)and C-reactive protein(CRP)(68.0(56.9,79.0)mg/L)of the patients in the non-specific infection group were significantly higher than those of the patients in the TB group respectively(38.5(24.0,54.5)years,(37.8±0.6)℃,6.5(5.2,7.4)×10^(9)/L,40.0(30.0,50.0)mm/1 h,24.0(18.0,28.0)mg/L),and those differences were statistically significant(U=914.000,P=0.000;t=4.320,P=0.000;U=1005.000,P=0.001;U=307.500,P=0.000;U=100.000,P=0.000).However,the onset time(1.5(1.0,2.0)months)of the patients in the non-specific infection group was significantly shorter than that of the patients in the TB group(6.0(4.0,7.8)months;U=120.000,P=0.000).The incidences of bone bridge formation showed in X-ray plain(38.1%(8/21)),sequestrum(38.1%(8/21))and paraspinal abscess(19.0%(4/21))showed in CT imaging of the patients in the non-specific infection group were statistically significantly different compared with those of the patients in the TB group(9.7%(17/176),72.2%(127/176),52.3%(92/176),χ^(2)=11.246,10.094,8.290 and P=0.000,0.001,0.004).In the non-specific infection group,the postoperative focus was uncured in 4 cases.Eventually they were cured by adjusting antibiotics treatment and performing debridement combined with continuous catheter irrigation and drainage.There was no recurrence during the follow-up.Conclusion Compared with the patients with spinal TB,the patients with non-specific infection were older,had higher peak value of body temperature,WBC count,ESR and CRP,but their onset time was shorter and they were more likely to have bone bridge and sequestrum which showed in imaging manifestations.By the treatment of drug and surgery,the patients could be completely cured without recurrence.
作者
姚黎明
董昭良
王连波
贾晨光
李卓
刘丰胜
YAO Li-ming;DONG Zhao-liang;WANG Lian-bo;JIA Chen-guang;LI Zhuo;LIU Feng-sheng(Department of Orthopedics,Hebei Provincial Chest Hospital,Shijiazhuang 050041,China)
出处
《中国防痨杂志》
CAS
CSCD
2021年第6期612-618,共7页
Chinese Journal of Antituberculosis
基金
河北省科学技术研究与发展计划项目(1120140287)。
关键词
结核
脊柱
骨疾病
感染性
疾病特征
诊断
鉴别
Tuberculosis
spinal
Bone diseases
infectious
Disease attributes
Diagnosis
differential
