Wedge J H, Oryschak A F, Robertson D E, Kirkaldy-Willis W H
Clin Orthop Relat Res. 1977 Mar-Apr(123):155-63.
Because of alarming delays in the diagnosis and treatment of vertebral osteomyelitis we have reviewed our experience over the past 15 years. Of the 36 cases, 25 were pyogenic and 11 tuberculous. Because of late referral there was a delay from onset of symptoms to diagnosis of at least three months in 13 patients. The reason for this was the failure of the initial physician to consider osteomyelitis in the differential diagnosis of a febrile illness associated with back pain. The majority of our patients from the onset did not have intense localized pain, tenderness and a high fever which is the classical clinical picture in this condition. Seven patients with a long history required surgical exploration and debridement of the lesion in order to eradicate the infection. The remainder did well on 6 to 12 weeks of antibiotic therapy. None required spinal fusion. Ten of 11 patients with spinal tuberculosis had curettage of the lesion and spinal fusion. Patients with diabetes, malignancy, alcoholism, corticosteroid therapy and recent lower urinary tract surgery were found to be at particular risk of developing spinal osteomyelitis. Very often it was difficult to identify differences in the presentation of pyogenic and tuberculous infections.
由于脊椎骨髓炎的诊断和治疗存在令人担忧的延误情况，我们回顾了过去15年的经验。在36例病例中，25例为化脓性，11例为结核性。由于转诊延迟，13例患者从症状出现到诊断的时间至少延迟了三个月。原因是首诊医生在鉴别诊断伴有背痛的发热性疾病时未考虑骨髓炎。我们的大多数患者从发病开始就没有出现这种疾病典型的临床症状，即强烈的局部疼痛、压痛和高热。7例病程较长的患者需要进行手术探查和病灶清创以根除感染。其余患者接受6至12周的抗生素治疗后情况良好。无人需要进行脊柱融合术。11例脊柱结核患者中有10例进行了病灶刮除术和脊柱融合术。发现糖尿病、恶性肿瘤、酗酒、接受皮质类固醇治疗以及近期接受下尿路手术的患者发生脊柱骨髓炎的风险尤其高。化脓性感染和结核性感染的表现往往很难区分。
