布鲁杆菌病性脊椎炎的临床影像学表现及外科治疗

The clinical characteristics and surgical treatment of brucellar spondylitis

目的探讨布鲁杆菌病性脊椎炎的临床表现、影像学特点与外科治疗方法。方法对21例布鲁杆菌病性脊椎炎患者进行临床、实验室和影像学检查，并采用药物、经皮置管引流和手术病灶清除术进行治疗。结果病灶多分布于腰椎，L4发病率最高。21例血清试管凝集法检查滴度均大于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，14例病原学检查阳性。18例患者入院前临床、X线及CT检查均误诊为脊柱结核，误诊率85．71％；经MR检查误诊8例，误诊率66．67％。14例患者经药物治疗无效，5例采用经皮置管引流术，9例采用手术病灶清除术治疗，病理均符合布鲁杆菌病性脊椎炎的细胞学表现。17例患者获得随访，随访时间1～2年，痊愈15例，好转2例，愈后无复发。结论布鲁杆菌病性脊椎炎临床与影像学具有特征性表现。无论是非手术还是手术治疗，长期、足量、联合、多途径敏感抗生素的应用是治疗和防治布鲁杆菌病性脊椎炎复发的最主要和最可靠方法。对具有手术指征者，正确选择手术方法可以控制病变部位发展，缓解疼痛，减少并发症。

Objective To improve the diagnostic and therapic level of brucellar spondylitis, the clinical characteristics and surgical treatment of the disease were discussed. Methods Twenty-one patients with brucellar spondylitis were retrospectively evaluated in terms of their clinical, laboratory, and radiologic features and their response to different treatment regimens. Results Twenty-one patients with brucellar spondylitis were examined by X-ray and CT scanning. Twelve patients were studied by MRI. Brucellar spondylitis involve more often in the lumbar vertebrae. The fourth lumbar vertebra was the most frequently involved region. In the test of serologic tube agglutination test, the titers of 21 cases were beyond 1：160; Rose bengal plate test were positive and the specific antibodies of the germ, as IgM and IgG were found by enzyme-linked immunosorbent assay in all of these patients. Brucella species was isolated from blood cultures in 14 patients. 18 cases were misdiagnosed as the spine tuberculosis before hospitalization, even having been underwent the clinical examination, X-ray and CT scanning. The rate of misdiagnosis was 85.71% ; 8 patients who measured by MRI were misdiagnosed, and the rate of misdiagnosis was 66.67%. After the 21 patients were diagnosed as brucellar spondylitis, antibiotics regimen were used. 5 patients were treated with percutaneous drainage, and the clearance of focal lesion was performed in 9 patients. The diagnosis of the disease was confirmed by pathological examination. In these 21 cases, 17 cases were followed up for 1-2 years, 15 cases healed, 2 cases relieved and none recurred. Conclusion Brucellar spondylitis has specific changes in clinical and radiologic features. The patients can be treated effectively with appropriate antibiotic combinations. Surgery is considered as the last resort in treating spinal brucellosis. If the indications are re- spected, the minimal invasive surgery or the focus removal surgery can shorten the course of therapy, relieved pain, and decrease complications.