Ross P M, Fleming J L
Clin Orthop Relat Res. 1976 Jul-Aug(118):190-8.
There has been a definite change in the natural history of vertebral osteomyelitis. At the turn of the century the disease was most often seen in younger people, accompanied by a high incidence of abscess formation and associated with a high mortality rate. Today the disease is more commonly seen in the older age groups and is only occasionally characterized by abscess formation. In addition it tends to be of a lower grade inflammatory reaction and has a better prognosis. A urinary tract infection is a common pre-existing condition. Diagnosis may be difficult particularly before the onset of destructive changes radiologically at 8 to 12 weeks. Biopsy by either open or closed methods might be necessary to establishe the diagnosis and isolate the causative organism which is usually Staphylococcus aureus. Epidural infection is the most devastating complication, particularly if neglected. The duration of treatment is determined by following the clinical symptoms, sedimentation rate, temperature curve and interval radiological changes. The prognosis is good and most patients will recover within one year.
脊椎骨髓炎的自然病程已发生了明确变化。在世纪之交，该病多见于年轻人，脓肿形成的发生率很高，且死亡率也很高。如今，该病在老年人群中更为常见，仅偶尔以脓肿形成为特征。此外，它往往炎症反应程度较低，预后较好。尿路感染是常见的基础疾病。诊断可能很困难，尤其是在8至12周出现放射学破坏性改变之前。可能需要通过开放或闭合方法进行活检以确立诊断并分离出通常为金黄色葡萄球菌的病原体。硬膜外感染是最具破坏性的并发症，尤其是如果被忽视的话。治疗持续时间根据临床症状、血沉、体温曲线及间隔期放射学变化来确定。预后良好，大多数患者将在一年内康复。
