布鲁杆菌病性脊柱炎的诊断与手术治疗

Diagnosis and surgical treatment of the Brucellar spondylitis

目的探讨布鲁杆菌病性脊柱炎的临床、实验室、影像学特点及手术疗效。方法2000年9月至2010年12月共手术治疗布鲁杆菌病性脊柱炎患者27例，男18例，女9例；年龄23～57岁，平均32．8岁。颈椎3例，胸腰椎8例，腰骶椎16例。17例以“脊柱结核”收治，2例以“腰椎间盘突出症术后”收治。根据患者的临床、影像学及血清学检查等，明确诊断为布鲁杆菌病性脊柱炎。8例行后路病灶清除、自体骨植骨内固定术；19例采用前路病灶清除，自体骨植骨内固定术。24例术中病灶局部放置链霉素粉剂（余3例链霉素皮试阳性）。术后支具外固定4-6周，口服药物1．5-3．0个月。临床疗效评价包括临床治愈率、疼痛视觉模拟评分及植骨融合率。结果27例均获得随访，随访时间6个月-4年，平均19．7个月。根据布鲁杆菌病性脊柱炎疗效评定标准：痊愈24例，有效3例。3例腰椎病变者因切口渗出、窦道形成，给予清创缝合或病灶清除内固定调整术后痊愈，愈后无复发。结论颈、胸、腰背部疼痛伴间歇性波浪热，结合影像学检查和特异性的血清凝集试验阳性可确诊布鲁杆菌病性脊柱炎。对于顽固腰痛保守治疗无效，椎体、椎间盘严重破坏造成椎体间不稳，脊髓、神经根受压，或伴较大难以吸收的椎旁脓肿或腰大肌脓肿者，彻底的病灶清除、自体骨植骨内固定手术，联合抗菌药物治疗是安全、有效的方法。

Objective To study the clinical, laboratory, imaging characteristics and surgical out- comes of Brucellar spondylitis. Methods The clinical, laboratory, imaging characteristics and surgical out- comes of 27 patients with Brucella spondylitis were analyzed in our department from September 2000 to De- cember 2010. There were 18 males and 9 females, aged from 23 to 57 years（average, 32.8 years ）.There were 3 cases in cervical vertebra, 8 cases in thoracolumbar vertebra, 16 cases in lumbosacral vertebra respective- ly. Before admission, 17 patients were misdiagnosed as tuberculosis, 2 ones were as postoperative change of lumbar disc herniation. Eight patients underwent posterior debridement, autologous bone grafting and instru- mentation, 19 cases were treated with anterior debridement, autologous bone grafting and instrumentation. Streptomycin was placed in localized lesions for 24 patients, except for 3 cases whose streptomycin skin test positive. External fixation brace were used for 4 to 6 weeks, oral medication was used for a half month to 3 months. Clinical evaluation included clinical cure rate, pain visual analog scale （VAS） and the fusion rate. Results All of 27 patients were followed up for an average of 19.7 months （range, 6 to 48 months）. Accord- ing to evaluation standard for Brucella spondylitis, 24 patients were cured, 3 patients got improvement. Three patients underwent the second operation owing to wound infection and sinus formation. Conclusion The pain of spine with intermittent fever, the imaging features as well as positive serum agglutination test can confirm the diagnosis of Brucellar spondylitis. Operation should be considered in patients with persistent pain and neurologic disorders as well as systemic symptoms. Instrumentation is effective and safe in the treatment of patients with spinal brucellosis following debridement, autogenous bone grafting, combined with antibiotic therapy.