布鲁杆菌性脊柱炎流行病学调查(张家口地区)及临床治疗相关研究

Clinical Epidemiological Investigation for Brucellar Spondylitis Occring in Zhangjiakou and Study on Its Therapy

目的：总结布鲁杆菌性脊柱炎流行病学特点及相关的治疗方法，为提高对该病的治疗效果提供科学依据。方法：通过对113例确诊患者采用5种不同药物配伍方法进行不同疗程治疗和对比研究，其中21例伴有较重腰大肌或椎旁脓肿、椎管内脓肿、坏死椎间盘、骨质破坏行微刨介入和手术切开治疗。结果：布鲁杆菌性脊柱炎女性发病率高，平均年龄41岁，坝上发病率高于坝下；主要集中在饲养、放牧牲畜行业；病灶分布多在腰椎，两个椎体受累最多，涉及L4的发病率最高并破坏最为明显；含强力霉素治疗组效果优于未含强力霉素组，差异有显著性（P〈0．05），以强力霉素＋庆大霉素＋磺胺甲基异嗯唑为首选，如增加疗程，疗效增加不明显；手术21例进行随访，2年以上者12例，1～2年者9例，治愈20例，治愈率（20／21）95．24％，好转1例，有效率100％，愈后元复发。结论：布鲁杆菌性脊柱炎临床流行病学具有特征性；无论是非手术还是手术治疗，长期、足量、联合、多途径敏感抗菌素的应用是治疗和预防本病复发的最主要和最可靠方法，但对具有手术指征者，正确选择微创术和手术病灶清除术可以控制病变部位发展，缓解疼痛，减少并发症。

Objective： To sum up the clinical epidemiodogical features of brucellar spondylitis and its relative therapeutical approaches and to provide scientific data for improving its diagnostic level. Methods：Collect clinical epidemiodogical materials from 113 cases diagnosed having brucellar spondylitis. Divide the patients into 5 groups and treat with 5 kinds of drug and different treatment courses then analyse the results. 21 patients who had bigger psoos abscess or paravertebral abscess,intraspinal abscess of spinal canal , necrotic IVD and major osteolasia underwent the minimal invasive surgury and the focus removal surgury. Results： Among the tt3 cases,female patients were more than the male, the average age was 41, the patients from BaShang were more than that from BaXia. They were infected mainly through raising and breeding beasts. Lumbars were the major locations of lesions and it was very common that two adiacent Lumbars were involed. L4 was the most common location of lesion and its demolishment was the most serioas. The curative effect for the group with doxycycline was better than that without doxycycline,and the difference was notable（P〈0. 05）. If the course of treatment was increased,curative effect increase was not obvious. 21 patients who underwent surgary were followed up. 12 patient were followed up more than 2 years,9 patients： 1～2 years. 20 cases were healed and the healing rate was 95.24%. 1 case was healed essentially, The effective rate was 100%. None of the reoecured. Conclusion：There are characteristic features in clinical epidemiology of the brucell spondylitis. Whether performing surgury or not, application of susceptive antibiotics adequately and jointly by varied approaches for a long time was the major and reliable method to treat and prevent it from recurring. But for the patients suitble for surgury,the minimal invasive surgury or the focus removal surgury can shorten the course of therapy,decrease the complications and increase the curative rate.