硬脊膜外脓肿4例临床分析
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摘要
目的探讨硬脊膜外脓肿的临床症状、影像学表现及治疗方法和预后。方法回顾性分析苏州大学附属第一医院自2013年1月—2017年11月收治的4例硬脊膜外脓肿患者(男1例,女3例)的临床资料。其中2例完全瘫痪患者未行手术治疗,予以抗感染、脱水等对症治疗;另2例未完全瘫痪患者行手术治疗。结合文献复习分析该病的临床特点、治疗方法及预后。结果 4例患者均表现脊柱疼痛、发热、肢体运动障碍等临床症状。2例未完全截瘫患者经手术及药物治疗后,症状均改善; 2例完全截瘫患者治疗后无明显效果。结论硬脊膜外脓肿的治疗效果及预后与病程缓急、患者全身状况及脊髓受压情况、手术是否及时等有密切关系。早期诊断、早期治疗对硬脊膜外脓肿患者的治疗效果和预后极为重要。
Objective To investigate the clinical symptoms,imaging findings,treatment and prognosis of spinal epidural abscess. Methods The clinical data of 4 patients of epidural abscess( 1 male and 3 female) who admitted in First Hospital Affiliated to Suzhou University from January 2013 to November 2017 were analyzed retrospectively. 2 patients with complete paraplegia were treated with anti-infective treatment infection,dehydration and other symptomatic treatments instead of surgical treatment. 2 patients with incomplete paraplegia underwent surgery. The clinical characteristics,treatment and prognosis of spinal epidural abscess were discussed. Results All 4 patients had clinical symptoms such as spinal pain,fever and limb movement restriction. The symptoms of 2 patients with incomplete paraplegia were improved after drug treatment and surgical treatment. 2 patients with complete paraplegia had no obvious effect after treatment. Conclusions The treatment and prognosis of epidural abscess are closely related to the course of disease,the general condition of patients,the condition of spinal cord compression and the operation time. Early diagnosis and treatment are very important for treatment and prognosis of patients with epidural abscess.
Objective To investigate the clinical symptoms,imaging findings,treatment and prognosis of spinal epidural abscess. Methods The clinical data of 4 patients of epidural abscess( 1 male and 3 female) who admitted in First Hospital Affiliated to Suzhou University from January 2013 to November 2017 were analyzed retrospectively. 2 patients with complete paraplegia were treated with anti-infective treatment infection,dehydration and other symptomatic treatments instead of surgical treatment. 2 patients with incomplete paraplegia underwent surgery. The clinical characteristics,treatment and prognosis of spinal epidural abscess were discussed. Results All 4 patients had clinical symptoms such as spinal pain,fever and limb movement restriction. The symptoms of 2 patients with incomplete paraplegia were improved after drug treatment and surgical treatment. 2 patients with complete paraplegia had no obvious effect after treatment. Conclusions The treatment and prognosis of epidural abscess are closely related to the course of disease,the general condition of patients,the condition of spinal cord compression and the operation time. Early diagnosis and treatment are very important for treatment and prognosis of patients with epidural abscess.
引文
[1]Wong SS,Daka S,Pastewski A,et al. Spinal epidural abscess in hemodialysis patients:a case series and review[J]. Clin J Am Soc Nephrol,2011,6:1495.
[2]Wetherington B,Khan TW. Epidural abscess during a spinal cord stimulator trial:A case report[J]. Pain Pract,2018,8:12691.
[3]Patel AR,Alton TB,Bransford RJ,et al. Spinal epidural abscesses:risk factors,medical versus surgical management,a retrospective review of 128 cases[J]. Spine J,2014,14:326.
[4]Madhuripan N,Hicks RJ,Feldmann EA,et al. A protocol-based approach to spinal epidural abscess imaging improves performance and facilitates early diagnosis[J]. J Am College Radiol,2018,15:648.
[5]Shah NH,Roos KL. Spinal epidural abscess and paralytic mechanisms[J]. Curr Opin Neurol,2013,26:314.
[6]Bureta C,Tominaga H,Yamamoto T,et al. Lumbar spine epidural abscess and facet joint septic arthritis due to streptococcus agalactiae:A case report[J]. BMC Surg,2018,18:16.
[7]Raut N,Nagar VR,Salles S,et al. Rehabilitation outcomes in spinal abscess patients with and without a history of intravenous substance abuse[J]. Am J Phys Med Rehabil,2017,20:865.
[8]Malani AN,Vandenberg DM,Singal BA,et al. Magnetic resonance imaging screening to identify spinal and paraspinal infections associated with injections of contaminated methylprednisolone acetate[J]. JAMA,2013,309:2465.
[9]Kainer MA,Reagan DR,Nguyen DB,et al. Fungal infections associated with contaminated methylprednisolone in Tennessee[J]. N Engl J Med,2012,367:2194.
[10]Addidle M,Pynn J,Grimwade K,et al. Epidural abscess caused by streptobacillus moniliformis[J]. J Clin Microbiol,2012,50:3122.
[11]Diehn FE. Imaging of spine infection[J]. Radiol Clin North Am,2012,50:777.
[12]Ropper AE,Ropper AH. Acute spinal cord compression[J]. N Engl J Med,2017; 376:1358.
[13]Safavi-Abbasi S,Maurer AJ,Rabb CH. Minimally invasive treatment of multilevel spinal epidural abscess[J]. J Neurosurg Spine,2013,18:32.
[14]Matsubara T,Yamada K,Sato K,et al. Clinical outcomes of percutaneous suction aspiration and drainage for the treatment of infective spondylodiscitis with paravertebral or epidural abscess[J]. Spine J,2018,18:1558.
[15]Bridges KJ,Than KD. Holospinal epidural abscesses-Institutional experience[J]. J Clin Neurosci,2018,48:18.
[2]Wetherington B,Khan TW. Epidural abscess during a spinal cord stimulator trial:A case report[J]. Pain Pract,2018,8:12691.
[3]Patel AR,Alton TB,Bransford RJ,et al. Spinal epidural abscesses:risk factors,medical versus surgical management,a retrospective review of 128 cases[J]. Spine J,2014,14:326.
[4]Madhuripan N,Hicks RJ,Feldmann EA,et al. A protocol-based approach to spinal epidural abscess imaging improves performance and facilitates early diagnosis[J]. J Am College Radiol,2018,15:648.
[5]Shah NH,Roos KL. Spinal epidural abscess and paralytic mechanisms[J]. Curr Opin Neurol,2013,26:314.
[6]Bureta C,Tominaga H,Yamamoto T,et al. Lumbar spine epidural abscess and facet joint septic arthritis due to streptococcus agalactiae:A case report[J]. BMC Surg,2018,18:16.
[7]Raut N,Nagar VR,Salles S,et al. Rehabilitation outcomes in spinal abscess patients with and without a history of intravenous substance abuse[J]. Am J Phys Med Rehabil,2017,20:865.
[8]Malani AN,Vandenberg DM,Singal BA,et al. Magnetic resonance imaging screening to identify spinal and paraspinal infections associated with injections of contaminated methylprednisolone acetate[J]. JAMA,2013,309:2465.
[9]Kainer MA,Reagan DR,Nguyen DB,et al. Fungal infections associated with contaminated methylprednisolone in Tennessee[J]. N Engl J Med,2012,367:2194.
[10]Addidle M,Pynn J,Grimwade K,et al. Epidural abscess caused by streptobacillus moniliformis[J]. J Clin Microbiol,2012,50:3122.
[11]Diehn FE. Imaging of spine infection[J]. Radiol Clin North Am,2012,50:777.
[12]Ropper AE,Ropper AH. Acute spinal cord compression[J]. N Engl J Med,2017; 376:1358.
[13]Safavi-Abbasi S,Maurer AJ,Rabb CH. Minimally invasive treatment of multilevel spinal epidural abscess[J]. J Neurosurg Spine,2013,18:32.
[14]Matsubara T,Yamada K,Sato K,et al. Clinical outcomes of percutaneous suction aspiration and drainage for the treatment of infective spondylodiscitis with paravertebral or epidural abscess[J]. Spine J,2018,18:1558.
[15]Bridges KJ,Than KD. Holospinal epidural abscesses-Institutional experience[J]. J Clin Neurosci,2018,48:18.