MRI影像学分型对胸腰椎布鲁杆菌病性脊椎炎手术策略的效果分析

MRI classification on Brucellosis spondylitis: guidance value for treatment selection

[目的]探讨MRI影像分型对胸腰椎布鲁杆菌病性脊椎炎手术治疗选择及疗效分析。[方法]将2005年1月~2015年2月167例布鲁杆菌病性脊椎炎患者的MRI影像学资料,依据MRI分型行微创术与切开手术治疗;通过影像分析一致性检验、影像学评分、临床疗效评价进行性归纳总结。采用SPSS 15.0统计软件包进行分析。[结果]167例治疗前行MRI检查,6个月126例复查;12个月113例复查,影像分析一致性检验Kappa值均>0.75。依据术前MRI影像分型其治疗结果:选择微创14例(A组);153例选择病灶清除植骨术,56例未行内固定(B组),97例采用内固定(C组);各组12个月治愈率与前一个时间点比较差异有统计学意义(P<0.05);在6、12个月的时间点C组治愈率明显优于A组及B组,且A组优于B组,差异均有统计学意义(P<0.05)。[结论]布鲁杆菌病性脊椎炎MRI影像学分型对微创和手术治疗策略的制定具有重要价值及指导意义,内固定治疗布鲁杆菌病性脊椎炎效果优于其他治疗方法。

[Objective] To discuss the effect of MRI classification in the selection of operation methods for thoracic and lumbar vertebrae Brucellosis spondylitis and the operation effect. [Methods] The MRI imaging data of 167 cases of Brucellosis spondylitis from January 2005 to February 2015 were collected. According to the classification result, patients were given minimal invasive surgery or the open surgery. Based on pre-operative MRI classification, different treatment methods were selected, minimally invasive surgery was performed in 14 cases（Group A）, open surgery with debridement and bone graft were performed in 153 cases. In them, internal fixation was not performed in 56 cases as Group B and was performed in the other 97 cases, as Group C. The consistensy checking, imaging score and evaluation of clinical outcome were analyzed to investigate the correlation between MRI classification and the treatment effect. The data were analyzed by SPSS 15.0. [Results] After surgery, 126 cases were reviewed for 6 months and 113 cases were reviewed for 12 months. Kappa values were more than 0.75 in all cases from imaging consistency check. In all three groups, the healing rate at 12 months after the operation showed significant differences（P〈0.05） compared with results from previous time points. The healing rate of Group C was higher than those of Group A and Group B, while the healing rate of Group A was higher than that of Group B at the same time point of 6 months and 12 months after the operation, the differences had statistical significances（P〈0.05）. [Conclusion] MRI imaging classification for Brucellosis spondylitis has important value and guiding significance in the selection of conservative treatment, minimal invasive surgery or open surgery and in the open surgery, the effect of internal fixation is better than other methods.