布氏杆菌性脊柱炎与脊椎结核临床影像学表现比较  

The Comparison of the Manifestation of the Clinical Imageology Between the Brucellar Spondylitis and the Spine Turberculosis

作　　者：杨新明[1] 石蔚[2] 杜雅坤[3] 阴彦林[1] 孟宪勇[1] 邹宇炜[1] 

机构地区：[1]河北北方学院附属第一医院骨科,张家口075000 [2]河北北方学院附属第一医院儿科,张家口075000 [3]河北省儿童医院

出　　处：《临床放射学杂志》2008年第2期231-234,共4页Journal of Clinical Radiology

基　　金：河北省科学技术厅2007年第二批科学技术研究与发展指导计划项目(编号:071251)

摘　　要：目的探讨布氏杆菌性脊柱炎和脊椎结核的临床及影像学特点,以提高对该病的鉴别诊断水平。资料与方法回顾性分析16例布氏杆菌性脊柱炎患者的X线、CT、MR资料并与已确诊的38例脊椎结核影像学资料作比较。结果(1)布氏杆菌性脊柱炎病灶分布于腰椎,其中以L4发病率最高,骨破坏灶小而多发,多局限于椎体边缘,病灶周围明显增生、硬化,新生骨组织中有新破坏灶形成,椎间盘破坏轻,关节面增生硬化,相邻骨密度增高,少或无椎旁脓肿形成。(2)结核病灶分布于胸腰段,以椎体和椎间盘骨破坏为主并有死骨形成,椎旁脓肿和骨质疏松变化比较常见。结论依据布氏杆菌性脊柱炎和脊椎结核临床影像学特征性表现,两者可作出鉴别诊断。Objective To evaluate the clinical manifestation, radiological feature and surgical treatment of brucellar spondylitis. Materials and Methods 16 cases underwent X-ray and CT scanning,The lesion location of lumbar spine is more than that of thoracic spine,the most common location is L4, meanwhile,7 cases underwent MRI scanning ;16 cases shows that the titer of brucella seroagglutination test is over 1：160, the results of RBPT, the specific IgG and IgM antibodies to brucella in ELISA are positive;11 cases are positive in the aetiology examination. Results 14 cases were misdiagnosed as the spine tuberculosis by X-ray, CT scanning and clinical examination before they were hospitalized（ the rate of errordiagnosis was 87.5% ） ,5 cases undergoing MRI scanning were misdiagnosed as spine tuberculosis （ the rate of errordiagnosis was 71.43% ）. On admission,2cases received intervention therapy and 7 cases were treated with focus debridement on the basis of medicine therapy,the pathology results conformed to the presentation of brucellar spondylitis. 12 cases were followed up for an average of 1 - 2 years, 10 case were cured ,2 got relived and no recurrence occurred. Conclusion Brucellar spondylitis has specific manifestation in clinic and radiology;no matter non_surgical treatment or surgical treatment, the most important way to treat and prevent the recurrence of the brucellar spondylitis is the application of the long term, quantity, combing and multi_means susceptible antibiotic. But for the cases which has operation indication, selecting minimal invasive surgery and focus debridement correctly could decrease therapy course, reduce complications and improve cure rate.

关 键 词：布鲁氏菌病脊柱炎 脊椎结核 体层摄影术 X线计算机 磁共振成像 

分 类 号：R445[医药卫生—影像医学与核医学] R516[医药卫生—诊断学] R529.2[医药卫生—临床医学]