Rubayi S, Soma C, Wang A
Rancho Los Amigos Medical Center, Downey, CA 90242.
Arch Phys Med Rehabil. 1993 Nov;74(11):1186-91.
Six patients with spinal cord injury and iliopsoas abscess and other complicating conditions were evaluated with computed tomography (CT), conventional radiography, magnetic resonance imaging (MRI), and radionuclide scans. CT identified the presence of psoas abscess and revealed the depth, extent, and relationship of deep pressure ulcers to deep structures. CT-guided aspiration of the abscess cavities was performed in three patients, with placement of drainage catheters. Concurrent treatment with appropriate antibiotics, followed by staged myocutaneous flap coverage resulted successful outcomes in all patients. A high index of suspicion aids in the early diagnosis of psoas abscess in the SCI patient, as interpretations of physical examination are obscured by the lack of localizing findings. We believe that CT is the diagnostic and therapeutic modality of choice in the management of these complex conditions in the SCI patient, because of its superior ability to detect pathologic changes in the pelvic region and for decreasing the morbidity of the treatment by avoiding open surgery in these often suboptimal surgical candidates.
对6例患有脊髓损伤并伴有髂腰肌脓肿及其他并发症的患者进行了计算机断层扫描（CT）、传统X线摄影、磁共振成像（MRI）和放射性核素扫描评估。CT确定了腰大肌脓肿的存在，并揭示了深部压疮与深部结构的深度、范围及关系。对3例患者进行了CT引导下的脓肿腔穿刺抽吸，并放置了引流导管。所有患者在使用适当抗生素进行同时治疗，随后分期进行肌皮瓣覆盖，均取得了成功的治疗效果。由于体格检查的结果因缺乏定位性发现而难以判断，因此高度怀疑有助于脊髓损伤患者早期诊断腰大肌脓肿。我们认为，CT是脊髓损伤患者这些复杂病症治疗中首选的诊断和治疗方式，因为它在检测盆腔区域病理变化方面具有卓越能力，并且通过避免对这些通常手术条件不佳的患者进行开放手术，降低了治疗的发病率。
