背景:本病例报告介绍了一名妊娠期间合并泌乳相关骨质疏松症的化脓性脊柱炎(PS)患者。这位34岁的女性患者经历了一个月的腰痛,产后一个月开始,无外伤或发热史.腰椎的双能X射线吸收测定法显示Z评分为-2.45,从而诊断为妊娠和泌乳相关的骨质疏松症(PLO)。建议患者停止母乳喂养并口服钙和活性维生素D。她的症状恶化了,一周后她走路困难,促使她重访我们的医院.
方法:腰椎磁共振成像(MRI)扫描显示L4和L5椎体以及椎间隙中的异常信号,而增强扫描显示L4/5椎间盘周围异常增强的高信号,提示腰椎感染.穿刺活检进行细菌培养和病理检查,最终诊断为妊娠和哺乳期相关的骨质疏松症。抗骨质疏松药物和抗生素治疗后,病人的疼痛逐渐消退,她在5个月内恢复正常生活.巴解组织是一种罕见的疾病,近年来引起了越来越多的关注。妊娠期哺乳期脊柱感染也比较少见。
结论:这两种情况主要表现为下腰痛,但需要不同的治疗方法。在临床实践中,在诊断妊娠和哺乳相关的骨质疏松症时,应考虑脊柱感染的可能性。应根据需要进行腰椎MRI检查,以防止诊断和治疗延误。
BACKGROUND: This
case report presents a patient with pyogenic spondylitis (PS) associated with lactation-related osteoporosis during pregnancy. The 34-year-old female patient experienced low back pain for one month, beginning one month postpartum, with no history of trauma or fever. Dual-energy X-ray absorptiometry of the lumbar spine revealed a Z-score of -2.45, leading to a diagnosis of pregnancy and lactation-associated osteoporosis (PLO). The patient was advised to cease breastfeeding and take oral calcium and active vitamin D. Despite these interventions, her symptoms worsened, and she had difficulty walking one week later, prompting her to revisit our hospital.
METHODS: Lumbar magnetic resonance imaging (MRI) scans showed abnormal signals in the L4 and L5 vertebral bodies and intervertebral space, while an enhancement scan displayed abnormal enhanced high signals around the L4/5 intervertebral disc, suggesting a lumbar infection. A needle biopsy was performed for bacterial culture and pathological examination, culminating in a final diagnosis of pregnancy and lactation-related osteoporosis with PS. Following treatment with anti-osteoporotic medications and antibiotics, the patient\'s pain gradually subsided, and she returned to normal life within five months. PLO is a rare condition that has garnered increasing attention in recent years. Spinal infections during lactation in pregnancy are also relatively uncommon.
CONCLUSIONS: Both conditions primarily manifest as low back pain but require distinct treatments. In clinical practice, when diagnosing patients with pregnancy and lactation-associated osteoporosis, the possibility of spinal infection should be considered. A lumbar MRI should be conducted as needed to prevent delays in diagnosis and treatment.