Frisbie J H, Gore R L, Strymish J M, Garshick E
Spinal Cord Injury, Department of Veterans Affairs Medical Center, West Roxbury, Massachusetts 02132, USA.
J Spinal Cord Med. 2000 Spring;23(1):15-22. doi: 10.1080/10790268.2000.11753503.
Because vertebral osteomyelitis (VOM) appears to be relatively common among patients paralyzed due to myelopathy, a population of these patients was surveyed to A) estimate the incidence of VOM, B) identify risk factors, and C) review clinical features.
The cohort of 537 patients with myelopathy paralyzed prior to January 1, 1989 and subsequently hospitalized at the authors' facility over an 11-year survey period was surveyed. All were male, 93% had a traumatic etiology of paralysis, 50% were > or = 50 years of age, 53% were paraplegic, 54% were motor and sensory complete, and 56% had been paralyzed for 15 years or more. VOM was diagnosed by computerized tomographic demonstration of intervertebral end plate destruction and a positive culture of that site. The relative incidences of VOM were calculated as cases per spinal cord injury (SCI) and general hospitalizations; potential risk factors were assessed by rates of VOM in the myelopathy cohort and clinical features of VOM in these patients were noted.
Ten patients with myelopathy developed VOM, an incidence of 20.9 cases/10,000 SCI versus 1.8 cases/10,000 general hospitalizations. The risk ratio was 7.1 (p = .05) for paraplegia, 7.9 (p = .04) for motor and sensory completeness, and 4.4 (p = .06) for diabetes mellitus. The risk ratio for the 3 factors combined was 14.5 (p = .001). Initial clinical presentations were notable for back pain and plain radiographic films revealing paraspinal masses and pleural effusion.
Patients with myelopathy are uniquely at risk for VOM if their paralysis is at the paraplegic level and is motor and sensory complete.
由于在因脊髓病而瘫痪的患者中，脊椎骨髓炎（VOM）似乎相对常见，因此对这群患者进行了调查，以：A）估计VOM的发病率；B）确定风险因素；C）回顾临床特征。
对1989年1月1日前因脊髓病而瘫痪且在作者所在机构住院超过11年调查期的537例患者进行了调查。所有患者均为男性，93%的患者瘫痪病因是创伤性的，50%的患者年龄≥50岁，53%的患者为截瘫，54%的患者运动和感觉完全丧失，56%的患者瘫痪时间达15年或更长时间。VOM通过计算机断层扫描显示椎间盘终板破坏且该部位培养结果呈阳性来诊断。计算VOM的相对发病率，以每脊髓损伤（SCI）和普通住院病例数表示；通过脊髓病队列中VOM的发生率评估潜在风险因素，并记录这些患者VOM的临床特征。
10例脊髓病患者发生了VOM，发病率为20.9例/10000例SCI，而普通住院患者为1.8例/10000例。截瘫的风险比为7.1（p = 0.05），运动和感觉完全丧失的风险比为7.9（p = 0.04），糖尿病的风险比为4.4（p = 0.06）。这三个因素综合起来的风险比为14.5（p = 0.001）。最初的临床表现以背痛和X线平片显示椎旁肿块及胸腔积液为显著特征。
脊髓病患者若其瘫痪为截瘫水平且运动和感觉完全丧失，则患VOM的风险独特。
