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題 名 | Spinal Epidural Abscesses: A Retrospective Analysis of Clinical Manifestations, Sources of Infection, and Outcomes=硬脊膜上膿瘍:臨床表現、感染來源、與預後之回溯性分析 |
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作 者 | 陳先志; 昝文清; 雷大雅; | 書刊名 | 長庚醫學 |
卷 期 | 27:5 2004.05[民93.05] |
頁 次 | 頁351-358 |
分類號 | 416.292 |
關鍵詞 | 硬脊膜上膿瘍; 臨床徵狀; 感染來源; 預後; Spinal epidural abscess; Clinical manifestations; Sources of infection; Outcomes; |
語 文 | 英文(English) |
中文摘要 | 背景:硬脊膜上膿瘍在臨床上並不常見,若是能早期發現及處理,多能有不錯的預後;及之,則會造成嚴重的脊髓或神經傷害。此一回溯性研究主要是收集硬脊膜上膿瘍的病例,加以分析其臨床表現,感染來源,與相關預後。 方法:我們回溯緎收集自1997年3月至2003年4月間在本院神經外科所治療過之17例患有硬脊膜上膿瘍的病患,根據病歷資料加以分析其臨床表現、實驗室檢查、影像學發現及預後。 結果:全數病人都有接受外科手術及抗生素治療,平均年齡為63歲,男性佔絕大多數。頸背部疼痛、運動障礙及升高的C-reactive protein或紅血球沉降速率(erythrocyte sedimentation rate)值,是常覺見的臨床症狀。最常見的感染病源是oxacillino-resistant金黃色葡萄球菌;最常見的感染位置是在腰椎及椎管的前側部位。預後不佳的病人有29%,尚可的18%,而良好的有53%。 結論:在脊椎疾病病人併發腹部症狀的並不少見,特別是在胸椎部位;雖然神經缺陷可能因為脊髓壓迫而被腹部症狀所遮蔽,但是在縝密的檢查下,大多可以發現有脊椎疼痛及運動缺陷的存在。在疑似硬脊膜上感染,又有痛風病史的病人,除了檢體送檢培養之外,結晶體皆析也是需要的。雖然核磁共指影像使得我們得以更早期且更容易發現硬脊膜上膿瘍,但在任何有未知感染源及脊椎疼痛的病人,仔細且頻繁的病史詢問及理學檢查,仍是不可或缺的。 |
英文摘要 | Backgorund: spinal epidural abscess (SEA) is uncommon but has a potentially disastrous outcome. Its early recognition and management may lead to satisfactory results. We analyzed the clinical manifestations, sources of infection, and outcomes of patients with SEA. Methods: Between 1997 and 2003, 17 patients in the Department of Neurosurgery at Keelung Chang Gung Memorial Hospital had SEA. We retrospectively reviewed their records to analyze their clinical presentations, image findings, laboratory data, and clinical outcomes. Results: All 17 patients (mean age, 63 years) underwent surgery and received antibiotics. Back and/or neck pain (82%), motor deficits (70%), and elevated C-reactive protein levels or erythrocyte sedimentation rates (64%) were the most common symptoms and signs. The most common etiological organism was oxacillin-resistant Staphylococcus aurous. The SEA was commonly located in the lumbar spine, anterior to the spinal canal. Outcomes were poor in 29% of patients, fair in 18, and good in 53%. Conclusions: Abdominal complications in patients with spinal disease are not uncommon, especially when the thoracic level is involved. The abdominal symptoms may initially mask neurological deficits due to spinal cord involvement, however, spinal pain and motor deficits present in most cases under more thorough investigation. In a suspected SEA patient with a history of gouty arthritis, tissue biopsy should include additional crystal analysis. Although the increasing availability of MRI makes diagnosis easier and quicker, repeated neurological examination and full evaluation are essential in any patient with an unknown focus of infection and spinal pain or tenderness. |
本系統中英文摘要資訊取自各篇刊載內容。