Osteomyelitis of Multiple Lumbar Vertebrae Associated with Infected Aortic Aneurysm: A Case Report

本文報告一位73歲男性患者因腹部搏動腫塊及下背劇痛求診時，經由磁振造影檢查發現腹部主動脈瘤，已侵犯破壞第二至第四腰椎椎體前側且併發膿傷。在先給予第十二胸椎至第一薦椎間後方內固定術，再由前方經過徹底擴創，並切除被感染之主動脈瘤，移除膿瘍，繞行血管切除第二至第四腰椎椎體前側約三分之一後，以自體腓骨幹移植替代。由於細菌培養發現金色葡萄球菌，繼續以每天靜脈注射3次vancomycin 500 毫克4週後，再每天口服2次ciprofloxacin 500毫克至6個月。在術後4個月的追蹤期，紅血球沉降速率及C型反應蛋白質回復正常，臨床上已無顯著症狀。術後15個月以放射線檢查，未發現植入之腓骨幹有明顯脫落或被吸收。迅速正確診斷、徹底手術擴創及足夠抗生素治療，才能有效治癒。術後長節數之脊椎缺損，可以使用自體腓骨幹移植替代，用以維持脊柱前側穩定性。

關鍵字

骨髓炎,脊椎體,主動脈瘤

並列摘要

A 73-year-old male patient presented with a pulsating abdominal mass and intractable low pain for several days. Magnetic resonance imaging revealed an infected abdominal aortic aneurysm invading the second, third, and fourth lumbar vertebrae. He underwent radical debridement of the infected aneurysm with reconstruction using vascular bypass, partial corpectomy of the L2 to L4 vertebrae, anterior reconstruction with autogenous fibular shaft, and posterior instrumentation with posterolateral fusion. Culture of the necrotic tissues grew oxacillin-resistant Staphylococcus aureus. He received intravenous vancomycin infusion for 4 weeks and oral ciprofloxacin for 6 months postoperatively. After a 15-month follow-up, no apparent signs of further infection were noted. C-reactive protein and erythrocyte sedimentation rate returned to normal during follow-up. No neurologic symptoms other than mild low back soreness were noted. The stability of the lumbar spine was maintained using long segment reconstruction with autogenous fibula shaft and posterior instrumentation along with posterolateral fusion. Infected aortic aneurysm with vertebral osteomyelitis is a rare clinical entity. Prompt diagnosis and adequate treatment are essential.

並列關鍵字

osteomyelitis, vertebrae, aortic aneurysm

國際替代計量

Osteomyelitis of Multiple Lumbar Vertebrae Associated with Infected Aortic Aneurysm: A Case Report

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