布氏杆菌性脊柱炎临床影像学表现及外科治疗

Manifestation of clinical imageology and surgical treatment of the brucellosis spondylitis

[目的]探讨布氏杆菌性脊椎炎的临床表现、影像学特点与外科治疗,以便提高该病的临床诊断和治疗水平。[方法]本组16例均行X线摄片并行CT检查,病灶分布腰椎多于胸椎,其中L4发病率最高,其中7例行MRI检查;16例血清试管凝集法滴度均大于1∶160,虎红平板凝集试验阳性,酶联免疫吸附试验检查特异性抗体IgM、IgG阳性,11例作病原学检查。[结果]14例入院前临床、X线及CT误诊为脊柱结核,误诊率87.5%;经MRI扫描误诊5例,误诊率71.43%;本组16例入院确诊后,在药物治疗基础上,2例采取介入方法,7例采取手术病灶清除,病理符合布氏杆菌性脊椎炎的细胞学表现。本组仅12例(包括手术8例)进行随访1～2年,痊愈10例,好转2例,愈后无复发。[结论]布氏杆菌性脊椎炎临床与影像学具有特征性表现;正确选择微创术和手术病灶清除术可以缩短疗程,减少并发症,提高治愈率;无论手术还是非手术治疗,长期、足量、联合、多途径敏感抗生素的应用是治疗和防止本病复发的最主要和最可靠方法。

[ Objective] To improve the clinical diagnosis and therapic effect and to discuss the clinical and imageologic manifestations and treatment of the brucellosis spondylitis （BS）. [ Method ] Sixteen patients with BS were all taken radiographs and CT scanning and seven cases were also taken MRI. The test of SAT, test of RBP and ELISA were used in accessing BS. Pathogenic bacteria were examined in 11 cases. All cases were treated with anti-brucellosis agents and other conservative measures. Seven cases were followed with a focal debridement and 2 cases withminimal invasive surgery. [ Result] Fourteen cases were misdiagnosed as spine TB before they were hospitalized with rate of error diagnosis 87. 5%, even careful clinic and radiographic examination, and CT scanning had been taken, and 5 cases were misdiagnesed by MRI with the misdiagnosis rate 71.4%. The BS occurred far more in the lumbar vertebrae than in the thoracic vertebrae with its highest morbidity at the IA. Among 16 cases, the titers of SAT test were all beyond 1. 160, the test of RBP all showed positive and IgG, IgM showed positive by ELISA. Eleven cases was confirmed BS diagnosis by phthogenic bacteria examination. Only 12 cases were followed up for 1 -2 years （including 8 surgical-treated cases） . Ten cases were cured without recurrence, and 2 cases improved. [ Conclusion ] Brucellosis spondylitis commonly misdiagnose before hospitalization. Characteristic imageologic changes and clinical ap- pearance, combined tests of SAT and RBP are useful for diagnosis. Long-term and enough amount sensitive antibiotics and other conservative measures is still the major and reliable measures in treatment of BS and prevent recurrence, additional minimal invasive surgery or focal debridement could shorten the course of therapy, increase the cure rate and decrease its complication.