脊柱感染课件.ppt
,脊 柱 感 染,SPINE infections and related,1,t课件,概 念,累及椎间盘椎体附件感染可并发硬膜外脓肿,2,t课件,分 类,Pyogenic InfectionsFungal InfectionsTB Infections,3,t课件,化脓性感染,IncidenceNagel et al. (2) 8% of all osteomyelitis. 52% of the patients were older than age 50intravenous (IV) drug use (4).,4,t课件,病理基础,干骺部丰富静脉丛终末动脉分支椎体和椎间盘延续发展椎间盘分解-狭窄间隙,5,t课件,细菌学,单一细菌,金葡菌,50%G-,老年人 ,伴泌尿系感染,IV drug abusers慢性低毒性感染, 凝血酶阴性Staphylococcus,类白喉菌, 10 days 培养期,6,t课件,临床表现,90%疼痛,压痛肌痉挛50%;发热, with 20%小于3 weeks, 30% 3 weeks to 3 months, and 50% 超过 3 months duration 腰48%, 胸35%, 颈6.5%, 胸腰骶段Rest. 跳跃性4% to 5%,7,t课件,部分诊断困难,不发热血沉,病程指标白细胞正常病程和诊断时间长,最终活检确诊,8,t课件,出现瘫痪危险因素,老年平面高糖尿病类风关激素使用,9,t课件,影 像,X-RAY NEGATIVE -间隙狭窄,软组织阴影,晚期两侧椎体破坏CT:溶骨,椎旁软组织肿胀, 产气核素:并不优于MR;儿童老年人局部缺血灶MR: 椎体椎间盘低T1, T2 裂隙消失;增强的椎体和间盘,脓肿不增强,10,t课件,影 像,11,t课件,Biopsy Techniques,除了明确影像学临床血培养阳性. 血培养25% 阳性,12,t课件,非手术治疗,针对性抗生素培养阴性=广谱抗生素6-8周万古,替考拉宁, 庆大, 妥布, 克林可到达头孢青霉素类浓度低,13,t课件,手术治疗,活检阴性 体温高呈感染性临床表现;保守治疗失败血沉快;持续剧烈疼痛畸形骨破坏影像学进展; 神经症状,14,t课件,临床病例,15,t课件,椎管外脓肿,16,t课件,the titanium mesh cages, e titanium cages and PEEK cages were efficient in providing anterior fusion of the infected spine. the rate of subsidence was higher, and the interval until subsidence was shorter in the strut group than in the cage group.,17,t课件,18,t课件,19,t课件,Fungal Infections,少见临床症状隐匿开放检出率高,20,t课件,TB INFECTIONS,3% to 4% of all tuberculous skeletal system ,50% involve the spine,21,t课件,病源学,椎体前部85% to 90% 终板椎间盘-椎体胸腰段腰段,22,t课件,不同临床类型,23,t课件,晚期残留畸形,24,t课件,自然病史,畸形进展 活动期 静止期成人儿童差异,25,t课件,儿童结核自然病史,26,t课件,27,t课件,影像学,椎体疏松终板模糊毛燥, 椎间隙狭窄,早期/晚期椎体破坏后凸,28,t课件,影像学,29,t课件,化脓菌感染:感染症状明显,血培养和穿刺证实. 布氏菌感染:地域特点,波状热,椎体破坏少,新骨形成明显,明显硬化,血清学反应阳性。 转移瘤:椎间盘完好,骨破坏,椎弓侵犯. *椎旁脓肿,CT发现死骨,边缘强化支持TB,鉴别诊断,30,t课件,药物治疗,300 mg of isoniazid (INH) 600 mg of rifampicin 20 to 30 mg/kg of body weight pyrazinamide ethambutol (or streptomycin) when: (a) the severity of the lesion is extensive (b) the patient population has a high primary resistance to INH (c) there is a suspicion of drug resistance4药强化2月,2药9-12月维持,31,t课件,手术治疗,明确诊断引流脓肿清创融合同时行后路或2期后路融合,32,t课件,6 to 10 周临床治疗无改善复发耐药或者不规则药物治疗防止畸形窦道大的脓肿颈部脓肿导致呼吸吞咽困难,无神经症状结核手术指征,33,t课件,34,t课件,35,t课件,伴有神经症状 活动期结核保守治疗和药物治疗有效. 手术治疗更好的恢复及全身情况改善及减少 20% 需要外科手术 前路彻底减压清创植骨融合 后路手术限于后方结构受累及椎弓根病灶为主 后路手术对于前路病灶并不是首选 稳定期治疗更难,需要在后凸基础上进行减压,手术难度及风险大.,36,t课件,37,t课件,THANKS !,38,t课件,
