化脓性和结核性脊柱感染的评估与管理
Evaluation and Management of Pyogenic and Tubercular Spine Infections.
作者信息
Boody Barrett S, Tarazona Daniel A, Vaccaro Alexander R
机构信息
The Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
出版信息
Curr Rev Musculoskelet Med. 2018 Dec;11(4):643-652. doi: 10.1007/s12178-018-9523-y.
PURPOSE OF REVIEW
To review the most current diagnostic tools and treatment options for pyogenic and tubercular spine infection.
RECENT FINDINGS
Recent studies have focused on risk factors for failed nonoperative management in order to improve patient selection. Also, spine instrumentation and different grafting options have been safely utilized in the setting of an active infection without increasing the incidence of reoccurrence. However, the optimal surgical technique has yet to be established and instead should be patient specific. Spine infections include a broad spectrum of disorders including discitis, vertebral osteomyelitis, and spinal epidural abscess. It is paramount to recognized spine infections early due to the potential catastrophic consequences of paralysis and sepsis. The management of spine infections continues to evolve as newer diagnostic tools and surgical techniques become available. Magnetic resonance imaging with contrast is the imaging study of choice and computed tomography-guided biopsies are crucial for guiding antibiotic selection. Antibiotics are the mainstay of treatment and surgery is indicated in patients with neurological deficits, sepsis, spinal instability, and those who have failed nonoperative treatment.
综述目的
回顾目前用于化脓性和结核性脊柱感染的诊断工具及治疗选择。
最新发现
近期研究聚焦于非手术治疗失败的危险因素，以改善患者选择。此外，在存在活动性感染的情况下，脊柱内固定和不同的植骨选择已被安全应用，且未增加复发率。然而，最佳手术技术尚未确立，而应根据患者具体情况而定。脊柱感染包括多种疾病，如椎间盘炎、椎体骨髓炎和脊柱硬膜外脓肿。由于存在瘫痪和败血症等潜在灾难性后果，早期识别脊柱感染至关重要。随着更新的诊断工具和手术技术的出现，脊柱感染的管理也在不断发展。增强磁共振成像为首选影像学检查，计算机断层扫描引导下的活检对于指导抗生素选择至关重要。抗生素是治疗的主要手段，对于有神经功能缺损、败血症、脊柱不稳定以及非手术治疗失败的患者，需进行手术治疗。
Zotero 插件