Тактика хирургического лечения хронического остеомиелита позвоночника на фоне травматической плегии (спинальная нейроатропатия Шарко)

Спинальная нейроартропатия Шарко – редкое заболевание, которое обусловлено посттравматическими нарушениями проприорецепции и глубокой чувствительности. Проявляется формированием псевдоартрозов и нестабильности позвоночно-двигательных сегментов ниже места его повреждения. Цель исследования – изучить особенности клинического течения спондилитов на фоне спинальной нейроартропатии Шарко и оценить результаты их хирургического лечения. Дизайн – малая клиническая серия и обзор литературы. В исследование включены 10 клинических наблюдений пациентов со спинальной нейроартропатии Шарко, проходивших лечение в Санкт-Петербургском НИИ фтизиопульмонологии МЗ РФ с 2014 по 2024 гг. По результатам бактериологического и гистологического исследований пациенты разбиты на две группы. В группу А вошли четыре пациента с асептическим воспалением, а в группу Б – шесть пациентов с верифицированным гнойным воспалением, в посевах у этих пациентов в 66,7 % случаев (четыре пациента) выявлены популяции S. Epidermidis-1, S. aureus-1, E. coli-1, Prot. vulgaris-1. При своевременно проведенном хирургическом лечении большинство пациентов, особенно с неполной параплегией, имеют хороший ближайший прогноз. Однако в отдаленном периоде у 30 % пациентов проводятся реоперации из-за развития нестабильности позвонково-двигательного сегмента, формирования синдрома смежного уровня и\или прогрессирования воспалительного процесса в позвоночнике.

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