腰椎化脓性脊柱炎影像与病理特点
张耀;张强;赵昌松;王鹏;孙磊;赵汝岗;李鑫;孙胜;
摘要(Abstract)：
[目的]探讨腰椎化脓性脊椎炎影像与病理特点。[方法]回顾性分析2012年11月~2016年3月,16例行手术治疗的腰椎化脓性脊柱炎患者,其中男11人,女5人;年龄35~74岁,平均(49.21±7.42)岁。术前收集X线片、CT及MRI等影像学资料,术中收集病变组织,采用革兰氏染色和HE染色等进行组织病理观察。[结果]16例患者X线片显示病变椎间隙变窄,可见椎体骨质破坏。CT显示病变椎体骨质破坏、硬化,可见空洞形成。MRI显示病变椎体在T1WI像上表现为低信号或混杂低信号,在T2WI像上表现为高信号或混杂高信号,压脂T2WI呈高信号,增强后明显强化。16例患者病理学观察革兰氏染色可见革兰氏阳性菌,HE染色可见破坏组织内有大量的炎性细胞浸润,包括中性粒细胞、单核细胞等。[结论]腰椎化脓性脊柱炎影像学及病理学表现具有一定的特征性,对其临床诊断和鉴别诊断可提供重要的参考信息。
关键词(KeyWords)： 腰椎;化脓性脊柱炎;影像;病理
基金项目(Foundation):
作者(Author): 张耀;张强;赵昌松;王鹏;孙磊;赵汝岗;李鑫;孙胜;
Email:
DOI:
参考文献(References)：
- [1]Bornemann R,Muller-Broich JD,Deml M,et al.Diagnosis and treatment of spondylodiscitis/spondylitis in clinical practice[J].Z Orthop Unfall,2015,153(5):540-545.
- [2]Lee KY.Comparison of pyogenic spondylitis and tuberculous spondylitis[J].Asian Spine J,2014,8(2):216-223.
- [3]Hadjipavlou AG,Mader JT,Necessary JT,et al.Hematogenous pyogenic spinal infections and their surgical management[J].Spine(Phila Pa 1976),2000,25(13):1668-1679.
- [4]Salem KM,Fisher CG.Anterior column reconstruction with PMMA:an effective long-term alternative in spinal oncologic surgery[J/OL].Eur Spine J,2015.[Epub ahead of print]
- [5]Shiban E,Janssen I,da Cunha PR,et al.Safety and efficacy of polyetheretherketone(PEEK)cages in combination with posterior pedicel screw fixation in pyogenic spinal infection[J].Acta Neurochir(Wien),2016,158(10):1851-1857.
- [6]D Agostino C,Scorzolini L,Massetti AP,et al.A seven-year prospective study on spondylodiscitis:epidemiological and microbiological features[J].Infection,2010,38(2):102-107.
- [7]Fantoni M,Trecarichi EM,Rossi B,et al.Epidemiological and clinical features of pyogenic spondylodiscitis[J].Eur Rev Med Pharmacol Sci,2012,16(Suppl 2):2-7.
- [8]Boody BS,Jenkins TJ,Maslak J,et al.Vertebral osteomyelitis and spinal epidural abscess:an evidence based review[J].J Spinal Disord Tech,2015,28(6):316-327.
- [9]孙厚杰,蔡小军,韩建华,等.非特异性脊柱感染的诊断与治疗[J].中国脊柱脊髓杂志,2013,23(6):508-513.
- [10]Still JM,Abramson R,Law EJ.Development of an epidural abscess following staphylococcal septicemia in an acutely burned patient:case report[J].J Trauma,1995,38(6):958-959.
- [11]Jevtic V.Vertebral infection[J].Eur Radiol,2004,4(Suppl 3):43-52.
- [12]Yoon YK,Jo YM,Kwon HH,et al.Differential diagnosis between tuberculous spondylodiscitis and pyogenic spontaneous spondylodiscitis:a multicenter descriptive and comparative study[J].Spine J,2015,15(8):1764-1671.
- [13]Chang CY,Simeone FJ,Nelson SB,et al.Is biopsying the paravertebral soft tissue as effective as biopsying the disk or vertebral endplate 10 year retrospective review of CT guided biopsy of diskitis osteomyelitis[J].AJR Am J Roentgenol,2015,205(1):123-129.
- [14]Lury K,Smith JK,Castillo M.Imaging of spinal infections[J].Semin Roentgenol,2006,41(4):363-379.
- [15]甫拉提·买买提,盛伟斌,郭海龙,等.腰椎化脓性脊柱炎的手术治疗[J].中国修复重建外科杂志,2012,26(7):789.
- [16]Galhotra RD,Jain T,Sandhu P,et al.Utility of magnetic resonance imaging in the differential diagnosis of tubercular and pyogenic spondylodiscitis[J].J Nat Sci Biol Med,2015,6(2):388-393.
- [17]Moorthy S,Prabhu NK.Spectrum of MR imaging findings in spinal tuberculosis[J].Am J Roentgenol,2002,179:979-983.
- [18]Ledermann HP,Schweitzer ME,Morrison WB,et al.MR imaging findings in spinal infections:rules or myths[J].Radiology,2003,228(2):506-514.
- [19]周守国,王娟,赵晓梅,等.化脓性脊椎炎的MRI表现与分期(附50例道)[J].影像诊断与介入放射学,2011,20(3):218-221.
- [20]Cheung WY,Luk KD.Pyogenic spondylitis[J].Int Orthop,2012,36(2):397-404.