脊柱化脓性感染诊断与手术预后分析-外科学(骨外科)专业论文.docxVIP

浙江大学硕士学位论文治疗患者较好有统计学差异。(Fisher精确卡方检验，X2----6．429，P 浙江大学硕士学位论文 治疗患者较好有统计学差异。(Fisher精确卡方检验，X2----6．429，P =O．023) 结论：诊断化脓性脊柱感染需从多方面入手综合各种检查结果综合 判断：1．实验室检查中白细胞不能作为诊断感染的唯一证据。红细 胞沉降率较白细胞更加敏感。对于自细胞升高不明显的患者需结合 红细胞沉降率和C一反应蛋白综合判断。2．x线表现出现较晚故对 于有典型危险因素存在且腰背部疼痛患者不能放松警惕。3．CT对 于脊柱破坏的敏感性很高但表现无特异性，容易于结核相混淆。单 纯依靠CT诊断化脓性脊柱炎证据不充足。4．MRI对于化脓性脊柱 感染具有特异性，其表现为：T1加权像椎体低信号，T1和T2加 权像异常的椎问盘信号和组织内造影剂堆积。5．CT引导下穿刺活 检加细菌培养为术前确诊的可靠手段，但其使用范围有限且由于器 械技术等原因容易产生假阴性。 关键词：化脓性脊椎炎；诊断；治疗 2 浙江大学硬士学位论文Diagnosis 浙江大学硬士学位论文 Diagnosis of pyogenic vertebral osteomyelitis and analysis of operation prognosis Postgraduate Liuyu Tutor Chen weishan Department ofOrthopaedics,the SecondAffiliated Hospital ofMedical College ofZhejiang University,Hangzhou 3 10009，Zhejiang，China obj仪：ti代：Report 18 patients嘶m pyogenic vertebral o鼬∞mye断s．To improve the recognlzafion ofvertebral osteomyefifise and to diagnose this disease earlier． Methods：From January 2002 to May 2005，18 patinets with pyogenic vertebral osteomyelitis were studied by means of many medical examinations．10 of them were therapied with operations．and the others we∞therapied whithout operations． Results：ESR and CRP arc more sensitive than WBC．There黜special representations an in X-ray,CT and MRI,but only which in MRI aIe diffenfial．10 of 18 patients with vertebral osteomyelitis were operated and all of them were covered exceneⅡtly or well．8 of 15 patients were therapied without operations，and four of them were covered badly．The prognosis of vertebral osteomyelitis had statistical significance between patients whoⅥ眦operated and the on髂without 3 浙江大学硕士学位论文op既ations(X2=6．429，P----0．023)． 浙江大学硕士学位论文 op既ations(X2=6．429，P----0．023)． Condusion：Diagnose the disease earlier and make觚operation earlier c趾reduce Key words：vertebral osteomyelitis；diagnosis；therapy 4 脊柱化脓性感染诊断与手术预后分析浙江大学医学院 脊柱化脓性感染诊断与手术预后分析 浙江大学医学院 外科学(骨外科) 硕士研究生 刘 禹 导 师 陈维善教授 脊柱化脓性感染根据病变部位不同包括化脓性脊椎炎、化脓性 椎间盘炎、化脓性小关节病和硬膜外脓肿，其中化脓性脊椎炎最为 常见‘¨。国外对该疾病的报道较多而且近年来呈逐渐增多的趋势121。 我国骨科医生对该疾病的认识远不如脊柱结核，导致许多急性病例 不能早期作出诊断和治疗而转为慢性病