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화농성 척추골수염에 대한 임상적 고찰 Clinical Observation for Pyogenic Osteomyelitis of the Spine

대한정형외과학회지 1976년 11권 3호 p.579 ~ 587
조현오, 안제환, 노명선,
소속 상세정보
조현오 ( Cho Hyoun-Oh ) 
서울대학교 의과대학 정형외과학교실

안제환 (  ) 
서울대학교 의과대학 정형외과학교실
노명선 (  ) 
서울대학교 의과대학 정형외과학교실

Abstract


Clinical observation of thirty-eight cases of pyogenic osteomyelitis of the spine for the period of eleven years, from 1965, at Seoul National University Hospital was carried out with the following results.
1. The incidence of pyogenic osteomyelitis of the spine among total cases of the pyogenic osteomyelitis was 6.9% and the ratio between the spine tuberculosis and the pyogeni osteomyelitis of the spine was 1 ~ 0.067.
2. The sex ratio between male and female was 3.8:1 The incidence was higher in the second and third decade and the average prevalent age was 30.8 Years of age.
3. The site of infection was in the lumbar vertebrae in 25 cases (66 %) , thoracic in seven (19%) , lumbosacral in three, sacral in two and cervical in one.
In the region of a vertebra, the vertebral body was affected in 33 cases (87%) and the neural arch and processes in other 5 cases (13%).
4. The causative micro-organism was isolated in 27 cases from the diseased focus; coagulase positive staphylococcus in 18 cases (67%), streptococcus in one, salmonella in one and the mixed infection in two. .
5. Frequent clinical symptoms and signs were back pain, tenderness, ~ muscle spasm, fever and chillness, and limited motion of the spine.
6. The rcetgenographic findings were in order of disc space narrowing, destruction of the vertebral body, kyphosis or loss of lordosis, erosion, bony bridging or spur formation, sclerosis and paravertebral abscess.
7. The conservative treatment was performed in 14 cases. Among 7 cases in which the follow-up was possible, only 3 cases obtained the satisfactory result, four cases were readmitted for the recurrence and two cases among them needed the operative treatment later.
The operative treatment was peformed i~ 26 cases: The focal curettage with anterior interbody fusion through anterior-approach was carried out in 13 cases with the satisfactory result in almost all cases.
8. The advantages of the operative treatment were that the isolation of the offending organism was efficient and the´ definite -diagnosis was feasible, and especially in cases of anterior spinal fusion
the healing and union of the infected spine was better clinically and rcetgenographically in comparision with those of conservative treatment, in which the expected spontaneous fusion was not found in any case and the recurrence was also frequent.

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