布鲁氏杆菌病性脊柱炎的诊断及外科综合治疗

Diagnosis and Comprehensive Surgical Treatment of Brucella Spondylitis

目的探讨布鲁氏杆菌病性脊柱炎的诊断和外科综合治疗的临床效果。方法 2008年1月至2013年1月收治93例布鲁氏杆菌性脊柱炎患者,其中男59例,女34例;年龄21~65岁,平均（46.52±1.27）岁。通过流行病学史、临床表现、影像学检查、实验室及病理学检查确诊,其中22例患者具有非手术指证采用强力霉素＋利福平＋磺胺甲基异噁唑药物治疗（A组）,71例患者（颈椎6例、腰椎65例）具有手术指证在药物治疗基础上采用病灶清除植骨内固定术,治疗后3、6、12个月进行临床疗效评价。采用SPSS 15.0统计软件进行分析。结果 93例患者治疗后3个月随访率100%,6个月随访率A组86.36%、B组91.54%,12个月随访率A组77.27%、B组83.09%,末次随访时所有患者无药物不良反应及肝肾功能异常发生,手术患者切口愈合好,无断钉、断棒病例,颈椎和腰椎手术植骨均愈合,无植骨并发症,脊柱稳定。随着时间推移,各组治愈率均逐渐提高,6个月、12个月时间点与3个月时间点比较,差异均有统计学意义（P〈0.05）,但同一个时间点两组治愈率比较,差异均无统计学意义（P〉0.05）。结论依据流行病学史、临床表现、影像学特点、实验室检查容易作出诊断及鉴别诊断,长期、足量、联合敏感抗生素的应用是治疗和防止本病复发最主要和最可靠的方法,只要正确掌握非手术和手术指证均可以治愈病灶,提高临床疗效。

Objective To investigate the diagnosis and clinical effects of surgical treatment for brucella spondylitis. Methods Based on the evidences from epidemiologieal history, clinical manifestations, imaging, laboratory and pathology, 93 cases of Brucella spondylitis patients were diagnosed and treated in our hospital from January 2008 to January 2013.22 cases of patients with non -surgical indications were treated with doxycycline, rifampiein and sulfamethoxazole （A group） ,71 eases （6 cases of cervical spondylitis, 65 cases of lumbar spondlylitis ） with surgical indications underwent debridement and autograft with internal fixation on the basis of drug therapy. Clinical effects were assessed at 3,6 and 12 months after treatments and u- sing SPSS 15.0 statistical software for analysis. Results 3 - month follow - up rate of 93 cases was 100% ,6 - month follow - up rate in group A was 8 6. 3 6 % , group B was 91 . 5 4 % , 1 2 - month follow - up rate in group A was 7 7. 2 7 % , group B was 83.09%. Last follow - up showed that all patients were in good conditions. There were no adverse drug reactions and liver and kidney dysfunction. No broken nails or broken rods cases. Surgical incisions healed well. Cervical and lumbar spine bone healed without bone graft complications. The cure rates in all groups were gradually improved. Differences were statistically significant （P 〈 0.05 ）compared the cure rates at 3,6 and 12 months, but at the same time point, the difference was not statistically signif- icant between two groups （ P 〉 0.05 ）. Conclusion Brucella spondylitis is easy to make a diagnosis and differential diagnosis based on epidemiological history, clinical manifestations, imaging features and laboratory tests. A long -term, adequate, joint sensitive antibiotics are the most important and most reliable method to prevent recurrence of the disease. The correct threapy according to non -surgical and surgical indications can heal lesions and improve clinical outcomes.