布氏杆菌及结核性脊柱炎的鉴别诊断和治疗

Differential Diagnosis and Treatments of Brinell Coli Spondylitis and Atypical Tuberculous Spondylitis

目的：探讨布氏杆菌脊柱炎及结核性脊柱炎的鉴别诊断和治疗方法。方法：对23例布氏杆菌脊柱炎（布氏杆菌组）、18例不典型结核性脊柱炎（脊柱结核组）患者分别行后路手术，内固定后清除病灶，植骨融合，局部应用抗生素；术后继续规范化治疗，随访0.5-1年（布氏杆菌组）、1-2年（脊柱结核组）。结果：两组切口均一期愈合，无1例复发，JOA评分均明显升高，治愈率分别达到95.65%（布氏杆菌组）和94.44%（脊柱结核组）。结论：综合病史、临床特点以及影像学检查结果，运用病灶清除植骨融合内固定并保证有效的药物治疗，完全可以治愈脊柱感染性病变。

Objective To evaluate differential diagnosis and treatments of brinell coli spondylitis and tuberculous spondylitis and to improve the curative effects. Methods Twenty-three cases of brinell coli spondylitis （brinell coli group）, and 18 cases of atypical tuberculous spondylitis （spinal tuberculosis group） following posterior surgery respectively, and after internal fixation of clear lesions, bone graft fusion and local application of antibiotics were continuously studied with standardized treatment postoperatively, and followed up for 0.5-1 year （brinell coli group）,1-2 years （tuberculous spondylitis group）. The results of the two groups were studied and compared. Results The incisions of both groups were primarily healed. The brinell coli spondylitis patients continued to anti-inflammatory 2 weeks postoperatively, with follow-up time half a year to a year, showed no case of recurrence. Atypical tuberculous spondylitis patients, with postoperative anti-tuberculosis treatment 0.5-1 year, and 1 to 2 years follow-up, showed no recurrence. All wounds were primarily healed, all with normal body temperature, pain disappeared basically.JOA score were significantly increased in both groups after treatment, the effective rate was 100%, the cure rate being 95.65% （brinell coli group） and 94.44% （group spinal tuberculosis） Conclusion Synthesizing medical history, clinical characteristics and imaging findings, the clinical use of lesion clearance with bone graft fusion and internal fixation and applying the effective drug treatment, can completely cure spine infectious diseases.