Derouet N, Haettich B, Temmar Z, Dugard D, Puechal X
Service d'Accueil et d'Urgence, Centre Hospitalier, 194, vae. Rubillard, 72037 Le Mans Cedex, France.
Ann Med Interne (Paris). 2001 Jun;152(4):279-82.
Septic arthritis of the posterior lumbar joints is extremely rare in comparison with spondylodiscitis which is much more common. We report a case of an 86-year-old women with septic arthritis of the left L4-L5 lumbar facet joint associated with endocarditis. Arthritis diagnosis was made on CT scan and MRI, infection by Staphyloccocus aureus was proved by blood cultures. Heart growth was seen by echocardiography. Twenty-three cases were reported in the literature. Clinical and biological data failed to discriminate between facet joint septic arthritis and spondylodicitis. Diagnosis is established on imaging findings, computed tomography and magnetic resonance imaging, completed by blood cultures and, if they are negative, by aspiration-biopsy. Appropriate antimicrobial therapy is usually successful. Some back pain generally persists. In conclusion, lumbar pain with fever without spondylodiscitis is suggestive of septic arthritis of a lumbar facet joint. Epiduritis associated in 60% patients requires rapid treatment.
与更为常见的脊椎椎间盘炎相比，后腰椎关节的化脓性关节炎极为罕见。我们报告一例86岁女性，患有左L4-L5腰椎小关节化脓性关节炎并伴有心内膜炎。通过CT扫描和MRI做出关节炎诊断，血培养证实为金黄色葡萄球菌感染。超声心动图显示心脏增大。文献报道了23例。临床和生物学数据无法区分小关节化脓性关节炎和脊椎椎间盘炎。诊断基于影像学检查结果，即计算机断层扫描和磁共振成像，并通过血培养完善诊断，如果血培养结果为阴性，则通过穿刺活检。适当的抗菌治疗通常会成功。一些背痛通常会持续存在。总之，无脊椎椎间盘炎的发热性腰痛提示腰椎小关节化脓性关节炎。60%的患者伴有硬膜外炎，需要迅速治疗。
