36例布鲁氏杆菌性脊柱炎的诊断及手术治疗

Diagnosis and surgical treatment of brucellar spondylitis

[目的]探讨布鲁氏杆菌性脊柱炎的诊断方法和手术治疗效果。[方法]2007年1月～2010年1月共收治80例布鲁氏杆菌性脊柱炎患者,回顾性分析其临床表现、实验室检查及影像学特点,均给予联合药物治疗,其中治疗组36例于联合药物治疗基础上采用手术治疗。[结果]80例患者均表现为发热伴多汗、腰部疼痛。实验室检查均有血沉、C反应蛋白增高,血清凝集试验(+)。影像学均有椎间盘变性及相应水平腰大肌病变,39例椎体后方软组织水肿明显,25例椎体前缘骨质破坏、硬化。治疗组全部患者均于术后3～7 d内自觉腰痛缓解。其中32例术后随访平均31个月,无1例发热、腰痛症状复发及血沉增高。[结论]布鲁氏杆菌性脊柱炎可依据典型的临床表现、特殊的实验室检查及影像学特点明确诊断,在联合药物治疗基础上,对存在手术指征的患者采用手术治疗可以取得满意的效果。

[ Objective] To discuss the diagnosis and surgical treatment of brucellar spondylitis. [ Method] Thirty- six cases with brucellar spondylitis undergoing the surgical treatment were based on the combined pharmacotherapy from Jan 2007 to Jan 2010 were reviewed retrospectively as a part of 80 cases, their clinical presentation,laboratory findings and inconography features were reviewed. [ Result ] Fever, hyperhidrosis and lumbodynia were noted in all cases. ESR and CRP value increased with brucel- lar agglutination titer positive in all cases. Intervertebral disc degenerations and the corresponding levels of psoas lesions were evi- denced in all cases by imageology,soft tissue edema posterior vertebrae in 39 cases, anterior border of vertebrae destruction and sclerosis in 25 cases. After surgical treatment based on the combined pharmacotherap, all cases felt lumbodynia relieve in 3 - 7 days. After postoperative follow - up for 31 months on average of 32 cases, no case had recurrence of fever and lumbodynia with ESR lowering in normal. [ Conclusion] Brucellar spondylitis has characterized clinical manefestations, special laboratory findings and radiographic features ,which can be treated successfully by combination of medicine and operation. Patients who have opera- tion indication could acquire satisfactory effect after surgical treatment.