布鲁氏杆菌性脊柱炎的诊治体会

Experience in diagnosis and treatment of Brucellar spondylitis(a report of 18 cases)

目的 探讨布鲁氏杆菌性脊柱炎的诊断及治疗疗效.方法 选择云峰医院2009年～2012年诊治的布鲁氏杆菌性脊柱炎患者18例,病变部位包括T12-L1：3例,L1：2例,L2-3：4例,L3-4：4例,L3-5：2例,L5-S1：2例,L4-S1：1例.18例患者中,保守治疗5例,使用多西四环素、利福平、链霉素联合用药;手术治疗13例,采取腰椎前路或后路病灶清除、髂骨取骨内固定.术后随访2年.结果 全部患者均获得满意效果.保守治疗5例中有2例在剧烈劳动后会出现轻微下腰痛;手术患者植骨均融合,其中前路手术组有1例患者偶有午后低热、乏力;后路手术组中有1例患者残留轻微下腰痛伴有不同程度下肢不适.结论 布鲁氏杆菌性脊柱炎通过合理选择治疗方案,单纯药物和药物联合手术均可取得满意疗效.

Objective To report the clinical experience in treatment and diagnosis of Brucellar spondylitis. Methods Eighteen patients with brucellar spondylitis were included the study and the lesion distribution was from T12 to S1. Of 18 cases, 5 received conservative treatment and 13 underwent surgical treatment. All patients were administrated a combined modality therapy including doxycycline, rifampicin, and streptomycin. Surgical procedure was performed through cleaning the lesion, grafting iliac crest bone for intervertebral bone and fixation, from anterior or posterior lumbar approach, Followup was 2 years. Results All of the patients got good effect. Two conservative treatment cases had slight pain on low back after strenuous labor. And in those who underwent surgery, one had low fever, one case had minor residual pain on low back and felt discomfort on lower extremity. Conclusion With reasonable treatment plan, Brucellar spondylitis could get satisfactory curative effect by combined surgery with drugs or drug alone.