布鲁杆菌性脊柱炎的影像学表现及治疗

Imaging findings and treatment of Brucellar spondylitis

目的探讨布鲁杆菌性脊柱炎的影像学表现及治疗方法。方法分析30例布鲁杆菌性脊柱炎患者的临床资料、影像学资料、实验室检查情况、诊断过程、治疗方法。结果患者均获得随访,时间3~12个月。初次准确诊断24例,6例误诊为脊柱结核。9例临床仅表现为腰痛,无明显脊髓神经根症状,给予多西环素及链霉素联合用药治疗2~3个月;21例脊髓神经根症状明显,影像学检查椎体破坏严重,椎旁脓肿明显,采用手术+药物联合治疗。末次随访时,29例腰痛及神经根症状均缓解,日常活动能力均恢复;1例间断性腰痛;30例均标准血清试管凝集法检查滴度<1∶160。结论布鲁杆菌性脊柱炎早期主要临床症状为发热、乏力、关节疼痛,影像学缺乏特征性表现,常发生误诊或漏诊。对于疑似者,可通过详细询问病史、查体、影像学检查及实验室检查尽快明确诊断。对于明确诊断者,应根据患者症状及影像学表现给予合理的治疗方案,临床效果满意。

Objective To investigate the imaging findings and treatment method of Brucellar spondylitis.Methods The clinical data,imaging data,laboratory examination,diagnostic process and treatment methods of 30 patients with Brucellar spondylitis were analyzed.Results All patients were followed up for 3~12 months.The 24 cases were diagnosed correctly for the first time,and 6 cases were misdiagnosed as spinal tuberculosis.Nine patients with only low back pain and no obvious spinal nerve root symptoms were treated with doxycycline and streptomycin for 2~3 months;21 cases with obvious symptoms of spinal nerve root,serious destruction of vertebral body and obvious paravertebral abscess were treated with surgery and drugs.At the last follow-up,29 cases of low back pain and nerve root symptoms were relieved,the ability of daily activities was recovered,and 1 case of intermittent low back pain.The titer of standard serum test tube agglutination method of 30 cases were less than 1∶160.Conclusions The early clinical symptoms of Bruellar spondylitis are fever,fatigue,joint pain,at the same time,which lack of characteristic imaging manifestations.So misdiagnosis or missed diagnosis often occur.For suspected patients,a definite diagnosis can be made as soon as possible through asking detailed medical history,physical examination,imaging examination and laboratory examination.For patients with accurate diagnosis,reasonable treatment plan should be given according to the symptoms and imaging findings,the clinical effect is satisfactory.