布氏杆菌性脊柱炎影像表现及治疗

Image manifestations and surgical treatment of spondtlitis caused by brucells infection

目的分析布氏杆菌性脊椎炎的影像学表现与治疗。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,血清试管凝集法常规检查及ELISA特异性抗体IgM、IgG检测。结果本组16例入院经作CT检查,7例MRI检查,血清凝集滴度（1∶160,ELISA检测之IgM、IgG均阳性而获确诊,在药物对症与抗菌治疗基础上,2例采取介入方法,7例采取手术病灶清除。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。结论布氏杆菌性脊椎炎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;无论手术与否,长期、足量、联合、多途径敏感抗菌素的应用是治疗和防止本病复发的最重要和最可靠的疗法。

In the present study, 16 cases of spondilitis were taken with X-ray examination and CT or MRI scanning and the serum antibodies against brucella antigen were detected by tube agglutination test and ELISA. It was found that the image manifestations of these cases with spondilitis appeared most frequently in the lumbar vertebra than in the thoracic vertebra,especially in the lumbar 4 vertebra（L4）. The diagnosis of infection with brucella was established by the positive results in serum agglutination test （serum antibody titer over 1 ： 160）and the positive reaction of specific IgM and IgG antibodies. On the basis of symptomatic and anti-bacterial treatment,2 cases were undergone with the minimal invasive surgery,and the focus-removal surgery was performed for another 7 cases. Follow-up examination 1-2 years later was done for these 12 cases including 8 cases with surgical intervention,in which 10 cases were found to be healed and 2 cases relieved.