Chuo Chin-Yi, Fu Yin-Chih, Lu Yen-Mou, Chen Jian-Chih, Shen Wun-Jer, Yang Chung-Hsien, Chen Cheng-Yen
Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
J Spinal Disord Tech. 2007 Jun;20(4):324-8. doi: 10.1097/BSD.0b013e31802c144a.
The number of intravenous (IV) drug abusers has been increasing in recent years. They are generally younger and healthier than the typical patient with a spinal infection. Reviewing the English language literature, there are only a few articles discussing the relationship between IV drug abuse and spinal infection. We studied 21 IV drug abusers with spinal infection. All were male, 19 were in their 30s and 40s with a mean age of 44 years. The mean follow-up period was 41 months after surgical intervention. Mild and severe neurologic deficit were seen in 5 and 13 patients (Frankel Grade C in 5, Grade D in 8), respectively. The overall positive culture rate was 17 out of 21 (81%). Twelve patients were infected with Staphylococcus aureus and 3 with Pseudomonas aeruginosa. Two had Mycobacterium tuberculosis. All were treated with anterior debridement and strut bone grafting with or without posterior instrumentation, laminectomy and abscess excision, or with additional discectomy. All patients with neurologic deficit recovered to a normal status. At the most recent follow-up, all the spine segments had fused and no one complained of any recurrent back pain. There were no postoperative complications. Physicians need to be more alert to the possibility of spinal infection in IV drug abusers with back pain. In addition to Staphylococcus aureus, Pseudomonas aeruginosa and Mycobacterium tuberculosis may be seen among IV drug abusers.
近年来，静脉注射吸毒者的数量一直在增加。他们通常比患有脊柱感染的典型患者更年轻、更健康。查阅英文文献，只有少数几篇文章讨论了静脉注射吸毒与脊柱感染之间的关系。我们研究了21例患有脊柱感染的静脉注射吸毒者。所有患者均为男性，19例年龄在30多岁和40多岁，平均年龄为44岁。手术干预后的平均随访期为41个月。分别有5例和13例患者出现轻度和重度神经功能缺损（5例为Frankel C级，8例为D级）。21例患者中共有17例（81%）培养结果呈阳性。12例患者感染金黄色葡萄球菌，3例感染铜绿假单胞菌。2例感染结核分枝杆菌。所有患者均接受了前路清创和支撑骨移植，伴或不伴后路内固定、椎板切除术和脓肿切除术，或额外进行椎间盘切除术。所有有神经功能缺损的患者均恢复到正常状态。在最近的随访中，所有脊柱节段均已融合，且无人抱怨有复发性背痛。无术后并发症。医生需要更加警惕背痛的静脉注射吸毒者发生脊柱感染的可能性。除金黄色葡萄球菌外，静脉注射吸毒者中还可能出现铜绿假单胞菌和结核分枝杆菌。
