The Senile Brucellosis Spondylitis Clinical Diagnosis and Treatment on as Evaluation Were Retrospectively Analyzed

Objective: To explore senile brucellosis spondylitis clinical features and diagnostic criteria, in order to improve the diagnosis rate and evaluate the clinical effects of treatment strategies. Methods: From January 2002 to August 2015, 62 patients with Brucella-associated spondylitis were treated with comprehensive diagnosis based on epidemiological history, clinical manifestations, imaging findings, laboratory tests, and local biopsy. The positive rate of red plate agglutination test (RBPT) was 45.1%, the positive rate of serum tube agglutination test (SAT) was 51.6%, and the positive rate of brucellosis anti-human immunoglobulin test (Coomb’s) was 100%. All patients underwent X-ray, CT and MRI examinations. The positive rate of blood culture in pathogenic examination was 16.1%, and the positive rate of bone marrow culture was 38.5%. The positive rate of inflammatory granuloma or abscess in the lesion sampling culture was 73.6%. All patients underwent standardized drug therapy and hyperbaric oxygen adjuvant therapy. Among them, 38 patients with neurological impairment were treated with one-stage debridement and posterior pedicle screw fixation on the basis of drug therapy. The paraspinal abscess and the diseased in-tervertebral space tissue were taken for pathological examination during the operation. One week, two weeks, one month, three months, six months and 12 months after treatment, the patients were evaluated and followed up at the monitoring sites. The evaluation indicators were pain scores, activity of daily living (ADL), imaging findings, and laboratory tests. The SPSS15.0 statistical package was used for analysis. Results: All patients were confirmed by the above-mentioned comprehensive examination after admission. 24 patients (38.71%) were treated with standard drug therapy (group A), no adverse drug reactions and abnormal liver and kidney function;the remaining 38 patients (61.29%) were combined with varying degrees of neurological impairment, and surgical treatment was performed after 2 to 4 weeks of drug therapy without improvement (group B). The pain scores showed that there was a statistically significant difference between the two groups at the same time point (P Conclusion: The senile Brucellosis spondylitis has a characteristic performance. The de-velopment of diagnostic criteria can help to improve the diagnostic rate. Standardized drug treatment has a good cure rate. The implementation of surgery has obvious advantages whether it is to relieve pain, stabilize the spine, restore nerve function, or recover early.

Intravoxel incoherent motion and dynamic contrast-enhanced MRI for assessing abnormalities of brucellosis spondylitis without conventional MRI changes

Objective To observe the value of intravoxel incoherent motion(IVIM)and dynamic contrast-enhanced MRI(DCE-MRI)for assessing abnormalities of brucellosis spondylitis(BS)without conventional MRI changes.Methods Data of 36 brucellosis patients with definite spinal lesions displayed on conventional MRI(BS 1 group),14 cases without brucellosis infection nor abnormal spinal signals on MRI(control group)and 36 brucellosis patients without definite spinal lesions on conventional MRI(BS 2 group)were retrospectively analyzed.The values of IVIM parameters,including perfusion fraction(f),pure water diffusion coefficient(D)and pseudo-diffusion coefficient(D*),also of DCE-MRI parameters,including time-intensity curve(TIC)type,volume transport constant(K trans),the rate constant(K ep)and volume fraction of extravascular extracellular space per unit tissue volume(V e)were compared among groups.Univariate and multivariate logistic regression were used to screen independent factors for discriminating BS 1 and BS 2.Receiver operating characteristic curves were drawn,and the areas under the curve(AUC)were calculated to evaluate the efficiency of the above parameters for discriminating BS 1 and BS 2.Results Among IVIM parameters,compared with control group,D*values decreased but D values increased in BS 1 group,while D*values increased in BS 2 group(all adjusted P<0.05).Compared with BS 2 group,BS 1 group had higher values of f and D and lower D*(all adjusted P<0.05).In BS 1 group,the TIC types were predominantly typeⅠ(23/36,63.89%),which were wholly or predominantly typeⅢin BS 2 group and control group,and of the former was significantly different with latter 2(both adjusted P<0.05).Compared with control group,K trans increased progressively in both BS 1 and BS 2 groups(both adjusted P<0.05).BS 1 group had lower K ep and higher V e than BS 2 and control groups(all adjusted P<0.05).Among univariate logistic regression models,the model including only f had lower capability for discriminating BS 1 and BS 2(AUC=0.759)than those including D,K trans and V e(AUC=0.951,0.833,0.894,all P<0.05).No significant different was found among multivariate logistic regression model including f and D,model including K trans and V e nor model including all above parameters(all P>0.05).Conclusion Both IVIM and DCE-MRI could be used to evaluate BS abnormality without conventional MRI changes.

Differential study of DCE-MRI parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis

Objective： In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to assess thevalue of DCE-MRI in the differential diagnosis of these diseases.Methods： Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor （30 cases of each）received conventional MRI and DCE-MRI examination. The volume transfer constant （Ktrans）, rate constant （Kep）,extravascular extracellular volume fraction （Ve） and plasma volume fraction （Vp） of the diseased vertebral bodieswere measured on the perfusion parameter map, and the differences in these parameters between the patients werecompared.Results： For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinaltuberculosis, respectively, the Ktrans values （median ＋ quartile pitch） were 0.989±0.014, 0.720±0.011 and0.317±0.005 min-1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min-1; the Ve values were0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; thecorresponding H values were 50.25 （for Ktrans）, 52.47 （for Kep）, 48.33 （for Ve） and 46.56 （for Vp）, and all differenceswere statistically significant （two-sided P〈0.05）.Conclusions： The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinalmetastatic tumor, brucellar spondylitis and spinal tuberculosis.

Clinical significance and prognostic value of tumor necrosis factor-α and dickkopf related protein-1 in ankylosing spondylitis

BACKGROUND Ankylosing spondylitis(AS)frequently occurs in people aged 30-45 years,and its prevalence is generally believed to be between 0.1%and 1.4%globally.At present,the“gold standard”for diagnosis of AS requires the provision of pelvic X-rays,which makes it more difficult to perform in population-based epidemiological studies.Therefore,the identification of serological indicators related to the diagnosis,treatment,and prognosis of AS patients is of great significance.AIM To analyze the therapeutic,diagnostic significance and prognostic value of dickkopf-related protein-1(DKK-1)and tumor necrosis factor-α(TNF-α)in AS.METHODS A total of 113 patients with active AS were selected as the research group,and 100 healthy subjects who underwent physical examination were selected as the control group.The levels of DKK-1 and TNF-α in peripheral blood in the two groups were compared.The diagnostic and predictive values of DKK-1 and TNF-α for AS were analyzed with ROC curves,and the factors influencing AS recurrence were analyzed with COX regression.RESULTS Before treatment,the research group showed lower DKK-1 levels but higher TNF-αlevels than the control group(both aP<0.05).In the research group,DKK-1 was up-regulated and TNF-αwas down-regulated after 12 wk of treatment(aP<0.05).The area under the curve,sensitivity and specificity of DKK-1 combined with TNF-αfor diagnosing AS were 0.934,82.30%and 97.00%,respectively.Before treatment,the area under the curve,cutoff value,sensitivity and specificity of DKK-1 for predicting the curative effect were 0.825,68.42 pg/mL,73.68%and 80.00%,respectively,and those of TNF-αwere 0.863,32.79 ng/L,92.11%and 77.33%,respectively.DKK-1 and TNF-αlevels after treatment were closely related to the curative effect(aP<0.05).C-reactive protein,the Bath Ankylosing Spondylitis Disease Activity Index,DKK-1,and TNF-αwere risk factors for AS recurrence(aP<0.05).CONCLUSION DKK-1 and TNF-αare effective in the diagnosis and treatment of AS and are risk factors for its recurrence.In addition,DKK-1 may be a potential target for the diagnosis of AS.

Pyogenic spondylitis caused by Escherichia coli: A case report and literature review

BACKGROUND Pyogenic spondylitis is often manifested as atypical low back pain and fever,which makes it easy to be confused with other diseases.Here we report a case of pyogenic spondylitis and describe the diagnosis and treatment based on the related literature.CASE SUMMARY The reported case suffered from pyogenic spondylitis caused by Escherichia coli and complicated with bacteremia and psoas abscess.Acute pyelonephritis was initially diagnosed due to atypical symptoms.Symptoms were improved from antibiotic treatment while developing progressive lower limb dysfunction.One month post the admission,the patient underwent anterior lumbar debridement+autogenous iliac bone graft fusion+posterior percutaneous screw-rod internal fixation,and received 6 wk of antibiotic treatment after the operation.Reexamination 4 mo post the operation showed that the patient had no evident pain in the waist,and walked well with no evident dysfunction of lower limbs.CONCLUSION Here we describe the application value of several imaging examinations,such as X-ray,computed tomography and magnetic resonance imaging,and certain tests like erythrocyte sedimentation rate and C-reactive protein in the clinical treatment of pyogenic spondylitis.This disease requires early diagnosis and treatment.Sensitive antibiotics should be used in early stages and surgical intervention should be taken if necessary,which may help for a speedy recovery and prevent the occurrence of severe complications.

Improvement of delayed diagnosis of ankylosing spondylitis in a Chinese population

To the Editor:Delayed diagnosis is a challenge in ankylosing spondylitis(AS),a representative phenotype of axial spondylarthritis(ax-SpA).Such delay might be improving,^([1])as there have been several updates on the diagnosis criteria of AS and ax-SpA,especially the 2009 Assessment of SpondyloArthritis International Society(ASAS),^([2])which recognized MRI as a powerful approach to detect early-stage lesions.However,there is still limited knowledge of whether the diagnostic delay has been improved in China.Therefore,we performed a comparative study of two datasets from the same hospital collected over 14 years.

Sex differences in outcomes of total hip arthroplasty for the treatment of ankylosing spondylitis

To the Editor:Ankylosing spondylitis(AS)has always been viewed as a male-dominated disease with previous studies showing a male-female ratio of approximately 3:1.However,more recent surveys have shown increasing[1]homogeneity in gender prevalence.1 Female patients with AS tend to have a longer diagnosis delay compared with male patients.AS patients with delayed diagnosis displayed worse outcomes in disease activity,function,spinal mobility,and radiographic damage.

青年官兵强直性脊柱炎(Anklosing spondyltis AS)的门诊关注及其处理措施

目的探讨提高青年官兵强直性脊柱炎的门诊诊断率，及时针对性的检查，诊断性的治疗，减少延诊漏诊。方法教育青年官兵坚持保存有连续的门诊记录，对19例血清阴性脊柱关节病严密跟踪检查治疗，得出满意的诊断和治疗。结果随访2年-6年，平均36个月，19例AS中，无一例病情恶化，临床症状都得到控制，血沉CRP，连续检查5次以上均在正常范围。结论强直性脊柱炎症在青年官兵中并不少见，由于其起病隐匿，早期又多无影像学阳性表现，加之患者多无保存门诊病历的习惯，以致极易延诊和漏诊。提至对不明原因的胸背间歇痛，血清类风湿子阴性的患者，要警惕AS的存在，拟诊为AS的血清阴性脊柱关节病病人，检查HLA—B27及关注症状性骶髂关节炎的存在，及时给予柳氮磺等标志性药物的综合治疗，19例病人得到了满意控制。

非牧区综合性医院布鲁菌性脊柱炎七例临床误诊分析

目的探讨布鲁菌性脊柱炎误诊脊柱结核的原因,以提高非牧区综合性医院布鲁菌性脊柱炎早期确诊率。方法回顾性分析2019年6月—2021年6月收治的布鲁菌性脊柱炎早期误诊脊柱结核7例的临床资料。结果7例均有近期牧区旅游史及牛羊接触史;1例有肺结核病史;病变部位:腰椎5例、胸椎2例;就诊前均曾自服解热镇痛药物。7例均持续性胸腰背疼痛伴活动受限、间断发热、乏力,全身关节游走性疼痛6例,食欲不振5例,脊柱局部压痛、叩击痛3例;肝脾大3例,颈淋巴结增大2例,睾丸疼痛1例。7例均初步诊断为脊柱结核。详细追问病史得知患者均有近期牧区旅游或出差史,行结核三项检查均阴性排除结核病,行布鲁菌血清学检测、虎红平板凝集试验及血清凝集试验均阳性,确诊布鲁菌性脊柱炎。误诊时间10~12 d。确诊后予利福平联合多西环素和(或)头孢曲松抗布鲁菌治疗患者症状均消失,随访半年预后良好。结论非牧区综合性医院布鲁菌性脊柱炎接诊率极低,接诊医师警惕性低,病史询问不详细,加之结核病史及解热镇痛类药物使用干扰诊断,使得容易误诊脊柱结核。非牧区综合性医院接诊医师应加强对该地区少见病的认识,提高警惕性,详细追问相关病史,尽早完善相关医技检查,综合分析病情,仔细鉴别诊断,以降低本病早期误诊率。

宏基因组二代测序技术在布鲁菌脊柱炎诊治中的应用价值

目的探讨宏基因组二代测序(mNGS)技术在布鲁菌脊柱炎诊治中的价值。方法手术治疗36例布鲁菌性脊柱炎患者,收集术前血液标本和术中病灶区组织标本(髓核、软骨终板、黄韧带、纤维环),采用Giemsa染色、试管凝集试验(SAT)、血培养、多重聚合酶链式反应技术(PCR)检测和mNGS评估不同组织样本。另选取30例椎间盘突出患者作为阴性对照组。结果静脉血的mNGS、SAT、多重PCR检测阳性率比较差异均无统计学意义(P>0.05)。髓核的mNGS与多重PCR检测阳性率比较差异无统计学意义(P>0.05)。软骨终板、黄韧带和纤维环的mNGS检测阳性率均大于多重PCR检测阳性率(P<0.05)。髓核中多重PCR和mNGS检测阳性率均高于静脉血、软骨终板、黄韧带和纤维环(P<0.05)。敏感性、阴性预测值:mNGS均高于Giemsa染色、血培养和SAT(P<0.05);mNGS与多重PCR检测比较差异均无统计学意义(P>0.05)。临床诊断一致性mNGS最好,多重PCR和SAT较好,Giemsa染色一般,血培养较差。结论mNGS可以作为布鲁菌脊柱炎的有效检测手段,其敏感性和准确率高,尤其适用于术前无法明确诊断且术后病理结果为阴性但需确诊的患者,可为布鲁菌脊柱炎的精准治疗提供重要的病原学依据。

血清SAA4和SOCS1对脊柱结核与化脓性脊柱炎的早期鉴别价值

目的探究血清淀粉样蛋白4(SAA4)和细胞因子信号传导抑制因子1(SOCS1)对脊柱结核(STB)与化脓性脊柱炎(PS)的早期鉴别价值。方法收集2019年1月至2021年6月就诊于新乡医学院第一附属医院的STB患者(STB组,n=62)和PS患者(PS组,n=52)一般资料,另将同期进行健康体检者50名作为对照组。酶联免疫吸附法(ELISA)测定血清SAA4和SOCS1水平;Logistic回归分析鉴别STB与PS的影响因素;受试者工作特征(ROC)曲线分析血清SAA4和SOCS1对STB和PS的鉴别价值。结果与对照组相比,STB组、PS组患者血清SAA4水平均升高,SOCS1水平均降低(P<0.05),且STB组SAA4和SOCS1水平均高于PS组(P<0.05);Logistic回归分析结果显示,血清SAA4和SOCS1是鉴别STB与PS的预测因素(P<0.05);ROC曲线结果显示,SAA4和SOCS1单独鉴别STB与PS的ROC曲线下面积(AUC)分别为0.833和0.872,敏感度分别为75.8%和75.8%,特异性分别为65.1%和66.9%,两者联合鉴别STB与PS的AUC为0.947,敏感度和特异性分别为88.7%和78.0%,两者联合鉴别的AUC显著大于SAA4和SOCS1单独鉴别的AUC(Z=2.683,2.015,P<0.05)。结论STB患者血清SAA4和SOCS1水平均显著高于PS患者,两者均可作为STB和PS的早期鉴别指标,且两者联合检测可提高鉴别诊断效能。

不典型强直性脊柱炎误诊原因分析

目的分析强直性脊柱炎(ankylosing sporidylitis,AS)误诊为腰椎间盘突出症、风湿热(rheumatic fever,RF)的原因及防范措施。方法回顾分析2021至2023年收治的AS误诊腰椎间盘突出症1例、RF 1例的病例资料。结果1例为31岁男性,因腰背部及右下肢疼痛伴晨僵3个月就诊,腰椎间盘CT检查示L_(4~5)椎间盘轻度突出,初诊为腰椎间盘突出症,后出现低热,查红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C reactive protein,CRP)升高、人白细胞抗原B27阳性,骶髂关节CT示双侧骶髂关节面有虫噬样改变,诊断为AS。1例为16岁青少年,因双踝双膝关节肿痛1年余、加重1月余就诊,因抗链球菌溶血素“O”试验(+),合并有多关节疼痛症状,诊断为RF,予苄星青霉素注射后症状好转停用后再发,后行骶髂关节MRI检查示双侧骶髂关节面局部融合,ESR与CRP升高,综合以上排除RF后诊断AS。误诊时间3个月、14个月。2例确诊后均予柳氮磺胺吡啶、甲氨蝶呤、重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白等治疗后症状消失,随访1~2年病情平稳。结论部分AS患者初期表现不典型,易误诊;加强对AS及相关疾病的认识、诊断及鉴别诊断能力,仔细采集病史,认真查体,早期行骶髂关节影像学检查及人白细胞抗原B27检测,结合临床表现和其他相关检查结果综合分析病情,可避免本病误诊的发生。

290例强直性脊柱炎患者中医证候的回顾性研究

目的:研究强直性脊柱炎患者中医证候分布规律,并为辨证分型提供客观证据。方法:选取2018年5月至2022年1月在云南省中医医院风湿科住院的强直性脊柱炎患者290例,收集患者的临床资料、中医证候、实验室指标等。结果:中医证候分布依次为肾虚督寒证、肾虚湿热证、肝肾亏虚证、痰瘀痹阻证。患者年龄与部分实验室检查存在相关性,强直性脊柱炎患者的红细胞沉降率(ESR)、C反应蛋白(CRP)、免疫球蛋白A(IgA)、血清总补体活性(CH50)、胆固醇(CHOL)和低密度脂蛋白(LDL-C)与中医证候存在相关性。结论:痰瘀痹阻证强直性脊柱炎患者的年龄偏大,肾虚湿热证的ESR、CRP、CH50较肝肾亏虚证患者高,CHOL、LDL-C、IgA、CH50与肾虚督寒证、肾虚湿热证、肝肾亏虚证、痰瘀痹阻证的辨证有着紧密联系。

强直性脊柱炎脊柱骨折临床及影像学特征分析

目的 探讨强直性脊柱炎患者脊柱骨折的临床及影像学特点,分析损伤机制并提高临床认识。方法 回顾性分析56例临床最终诊断为AS脊柱骨折患者的临床及影像学资料,依据损伤机制分为创伤性骨折和非创伤性骨折两组,对两组患者的年龄、性别、病程、骨折部位、累及范围、是否合并脊髓损伤等进行统计学分析,并总结两组患者的影像学特征。结果 56例患者,其中创伤性骨折32例,非创伤性骨折24例,经影像学分析及比较两组患者脊柱骨折发生部位、是否经椎间盘骨折、是否合并脊髓损伤差异均有统计学意义(P<0.05),但是否累及三柱差异无统计学意义(P>0.05)。结论 AS患者伴发的脊柱骨折,依不同受伤机制可分为创伤性骨折和非创伤性骨折,二者的发生部位、伴随损伤及影像学特征均有差异,综合应用CT和MR等影像学检查有助于减少漏诊,并做出明确诊断。

MRI在强直性脊柱炎Andersson病变分型中的价值

目的探讨MRI对强直性脊柱炎Andersson病变分型,并分析不同分型累及的椎单元情况,为强直性脊柱炎的早期诊断和治疗提供影像学依据。方法回顾性纳入行全脊柱MRI检查的强直性脊柱炎Andersson病变病人77例,其中男69例、女8例,平均年龄(44.0±12.2)岁。收集病人的一般临床资料和全脊柱MRI影像资料。由2名医师分析Andersson病变的MRI影像特征及其累及椎单元的特点,并根据Kim分型将该病变分为Ⅰ-Ⅴ型。采用Kappa检验分析2名医师对Andersson病变分型的一致性。结果2名医师诊断Andersson病变分型的一致性较好(κ=0.694,P<0.001)。Andersson病变共累及229个椎单元,208个椎单元仅存在1种分型病变,Ⅰ-Ⅴ型Andersson病变分别累及30(13.1%)、57(24.9%)、13(5.7%)、85(37.1%)、23(10.0%)个椎单元;21个椎单元同时存在2种分型的病变,Ⅰ+Ⅱ型有18个,Ⅱ+Ⅲ型1个,Ⅰ+Ⅲ型2个。结论MRI可清晰显示强直性脊柱炎的Andersson病变,并可对Andersson病变进行分型,对强直性脊柱炎的早期诊断与治疗方案的制定具有重要价值。

布鲁氏菌性脊柱炎的诊断和治疗

目的:探讨布鲁氏菌性脊柱炎的诊断方法和药物治疗效果。方法:2006年2月至2006年12月收治6例布鲁氏菌性脊柱炎患者,回顾性分析其临床表现、体征、影像学特点及实验室检查情况,均采用利福平和多烯环素联合药物治疗。结果:6例患者临床表现均为定时高热,腰背疼痛剧烈,大汗和乏力;局部深在叩压痛,无明确的神经受损体征。影像学显示椎间隙感染和邻近椎体骨髓炎征象。实验室检查血沉和C反应蛋白增高,血清布鲁氏菌凝集试验阳性,血培养有3例显示布鲁氏杆菌阳性。通过联合药物治疗2周后,6例患者发热大汗症状消失,其中4例腰背疼痛症状消失,2例患者腰背疼痛症状明显减轻;5例治疗3个月后,腰背疼痛症状消失,血沉和C反应蛋白降至正常,连续3次血培养阴性;1例未足程治疗者出现复发,继续治疗3个月后症状消失。均未出现并发症。结论:布鲁氏菌性脊柱炎可以通过典型的临床表现、影像特点及特殊的实验室检查明确诊断,采用利福平和多烯环素联合治疗可以取得满意的效果。

布氏杆菌性脊柱炎临床影像学表现及外科治疗

[目的]探讨布氏杆菌性脊椎炎的临床表现、影像学特点与外科治疗,以便提高该病的临床诊断和治疗水平。[方法]本组16例均行X线摄片并行CT检查,病灶分布腰椎多于胸椎,其中L4发病率最高,其中7例行MRI检查;16例血清试管凝集法滴度均大于1∶160,虎红平板凝集试验阳性,酶联免疫吸附试验检查特异性抗体IgM、IgG阳性,11例作病原学检查。[结果]14例入院前临床、X线及CT误诊为脊柱结核,误诊率87.5%;经MRI扫描误诊5例,误诊率71.43%;本组16例入院确诊后,在药物治疗基础上,2例采取介入方法,7例采取手术病灶清除,病理符合布氏杆菌性脊椎炎的细胞学表现。本组仅12例(包括手术8例)进行随访1～2年,痊愈10例,好转2例,愈后无复发。[结论]布氏杆菌性脊椎炎临床与影像学具有特征性表现;正确选择微创术和手术病灶清除术可以缩短疗程,减少并发症,提高治愈率;无论手术还是非手术治疗,长期、足量、联合、多途径敏感抗生素的应用是治疗和防止本病复发的最主要和最可靠方法。

MRI及病理学鉴别早期化脓性脊柱炎及布氏杆菌脊柱炎中的应用及价值

背景:病理学检测及MRI已在临床广泛应用,但将两者结合用于脊柱炎症早期鉴别诊断的研究较少。目的:通过观察病理与MRI征象改变,探讨病理学及MRI在早期化脓性脊柱炎与布氏杆菌脊柱炎鉴别诊断中的价值。方法:对22例化脓性脊柱炎及20例布氏杆菌脊柱炎患者行CT引导下经皮穿刺椎体活检及MRI检查,病理学切片观察结果包括病变骨组织结构及活力,组织细胞及其主要成分;MRI观察结果包括病变部位信号改变及征象变化。比较分析2组患者病理及MRI检查结果的构成比,统计方法为卡方检验。结果与结论:下列结果中,化脓性脊柱炎组发生率高于布氏杆菌脊柱炎组,且差异有显著性意义(P<0.05):嗜中性粒细胞浸润为主;椎间盘明显异常信号,椎体病变位置椎体前+后方,病变椎体形态明显变化,椎旁软组织异常信号,骨内或椎旁脓肿形成。提示病理学及MRI在早期化脓性脊柱炎与布氏杆菌脊柱炎的鉴别诊断中具有较高价值。

强直性脊柱炎的X线、CT、MRI诊断价值

目的探讨强直性脊柱炎X线、CT、MRI表现及其诊断价值。方法对50例诊断为强直性脊柱炎的影像学资料进行了回顾性分析和总结。结果50例均行X线检查,平片发现Ⅲ级以上的骶髂关节改变,主要表现为关节面破坏、间隙狭窄和关节强直,其中43例行CT检查发现Ⅲ级以下骶髂关节的改变,15例MRI检查显示关节腔、关节软骨、骨髓信号及关节囊等改变。结论强直性脊柱炎具有特征性的影像学表现,三种检查方法各有优势,影像学检查仍以X线平片为首选方法,若诊断有困难或需要与其他疾病鉴别时则考虑有选择性地应用CT或MRI检查。

强直性脊柱炎误诊情况分析

目的调查强直性脊柱炎(AS)误诊情况,分析误诊发生的原因。方法对中日友好医院中医风湿病科就诊的AS患者进行问卷调查,采用SPSS13.0软件进行统计学分析。结果 300例AS患者中首诊误诊率高达82.00%,1年内确诊率仅为17.67%。易误诊的前5种疾病为腰椎间盘突出、腰肌劳损、类风湿关节炎、坐骨神经痛、风湿性关节炎。外周关节发病、幼年发病、无AS家族史、非风湿病专科就诊均影响到AS的误诊率,性别及HLA-B27对误诊率没有显著性影响。结论 AS起病隐匿,临床误诊率高。被误诊的原因主要在于患者缺乏医学常识不能正确选择专科;二级以下医院缺少风湿病专科以及非风湿病专科医务人员对本病认识不足;幼年发病和以外周关节起病的AS患者的临床特征不典型易被忽视。应加强对广大风湿病患者的科普宣教以指导就医,提高非风湿病专科医生对AS临床特点及诊断方法的掌握,强调对于幼年起病及外周关节起病患者的临床追访观察,以期提高AS的早期诊断率。