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| 題 名 | 椎間盤感染引起背痛:個案報告=Low Back Pain Due to Infective Discitis: A Case Report |
|---|---|
| 作 者 | 林鴻錡; 劉金亮; 王德珍; 高木榮; | 書刊名 | 臺灣復健醫學雜誌 |
| 卷 期 | 35:1 2007.03[民96.03] |
| 頁 次 | 頁57-62 |
| 分類號 | 416.61 |
| 關鍵詞 | 下背痛; 椎間盤感染; 椎間盤軟骨切除術; Low back pain; Infective discitis; Discectomy; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 因椎間盤感染所引發背痛者並不常見,背痛病史中若發現有危險因子則應懷疑椎間盤感染,如有過久的下背痛、年紀大、其他感染、糖尿病或近期動過手術等危險因子,再加上發炎指數持續性上升,就應該把椎間盤感染納入鑑別診斷。磁振造影用於診斷椎間盤感染的敏感性很高。椎間盤感染的治療主要是抗生素治療,治療無效才應考慮開刀。本個案報告為一位66歲男性病患,下背痛伴有雙側大腿麻痛長達三年,腰部磁振造影顯示L4/L5脊椎狹窄,因而接受L4/L5椎板切除術及L4/L5椎間盤軟骨切除術,術後因傷口感染再接受清創重建手術。但手術後,病患仍覺下背痛,且越來越嚴重,手術部位傷口外觀清潔,僅發現發炎指數CRP及ESR上升。進一步追蹤磁振造影顯示L4/L5椎間盤感染,隨即接受L3-L5椎板切除術及內固定,同時給予抗生素治療。術後病患恢復狀況良好,可以緩慢步行不需攙扶。 |
| 英文摘要 | Infective discitis accompanying low back pain is uncommon. In general, risk factors for infective discitis include an age greater than 50 years, a history of cancer, unexplained weight loss, pain that lasts more than 1 month, a history of intravenous drug abuse, presence of a urinary tract infection or other infections, diabetes mellitus, and recent invasive procedures. The presence of an elevated erythrocyte sedimentation rate (ESR) and a C-reactive protein (CRP) level have proven to be reliable laboratory criteria consistent with infective discitis. Moreover, magnetic resonance (MR) imaging findings have been shown to have a good sensitivity for infective discitis. Antibiotics are considered the first line of treatment; however, if conservative treatment fails, surgery remains an option. We present herein a 66-year-old male patient who had low back pain with bilateral sciatica for 3 years. A lumbar spine MR image showed L4/L5 spinal stenosis. The patient underwent a L4/L5 laminectomy and a L4/L5 discectomy, then debridement for a wound infection. Progressive low back pain persisted in spite of a clean wound. Laboratory data showed a high CRP and ESR and repeat lumber spine MR imaging revealed L4/L5 infective discitis. Further treatment included a L3-L5 laminectomy, with internal fixation and administration of antibiotics. Postoperatively, the patient could walk independently for short distances with a slow gait. |
本系統中英文摘要資訊取自各篇刊載內容。