布鲁杆菌性脊柱炎临床疗效观察  

Investigation on the curative effect of brucellar spondylitis

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：《中国地方病学杂志》2008年第6期699-703,共5页Chinese Jouranl of Endemiology

摘　　要：目的观察布鲁杆菌性脊柱炎临床治疗效果，为提高该病的I临床治疗水平提供科学依据。方法收集张家口地区113例确诊患者临床流行病学资料，并用5种不同药物（强力霉素、庆大霉素、磺胺甲基异噁唑、链霉素、利福平）按不同配伍方法分成5组，进行治疗效果对比研究，其中伴有较大腰大肌或椎旁脓肿、椎管内脓肿、坏死椎间盘、骨质破坏较重的21例患者进行了微创介入和手术切开治疗。结果布鲁杆菌性脊柱炎女性发病率较高，主要为饲养、放牧牲畜而受感染，病灶分布多在腰椎，2个椎体受累最多，涉及腰椎LJ4的发病率最高并破坏最为明显。含强力霉素治疗组临床改善情况优于未含强力霉素组（χ^2=28．36，P〈0．05），治愈率分别为72．60％（53／73）、35．00％（14／40），二者比较差异有统计学意义（χ^2=15．14，P〈0．05）。治疗效果以强力霉素＋庆大霉素＋磺胺甲基异嗯唑为首选。1个疗程总治愈率为52．21％（59／113），总有效率为92．04％（104／113）；2个疗程总治愈率为58．41％（66／113），总有效率为95．58％（108／113）；3个疗程总治愈率为59．29％（67／113），总有效率为95．58％（108／113）；不同疗程总治愈率增加不明显（P〉0．05）。21例经手术治疗患者，随访2年以上者12例，1～2年者9例，总治愈率为95．24％（20／21），基本治愈1例，有效率100％，痊愈后均无复发。结论布鲁杆菌性脊椎炎具有临床流行病学特征；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，但对具有手术指征者，正确选择微创术和手术病灶清除术可以控制病变部位发展、缓解疼痛，减少并发症。Objective To investigate the curative effect of brucellar spondylitis, so as to provide scientific proof for improving the curative level of the disease. Methods Epidemiological information was collected from 113 patients diagnosed as brucellar spondylitis, who were divided into 5 groups according to different dings and drug combinations of doxycycline, gentamicin, sulfamethoxazole and rifampicin. Then the curative effect was investigated. Twenty-one patients who had greater paoas muscle abscess or Para vertebral abscess, intraspinal abscess of spinal canal, necrotic intervertebral disk and major osteolasia received the minimal invasive surgery and the focus removal surgery. Results The occurrence of the disease in female was much higher than that in male. Grazing and breeding beasts was the principal route of infection. Lumbars was mostly involved, they usually was infected in the adjacent 2 piece. L4 was the most common and seriuous one. The curative effect of doxycycline group was better than that without doxycycline （72.60% vs 35.00%, χ^2= 15.14, P 〈 0.05）. Doxyeyeline ＋ gentamicin ＋ sulfamethoxazole was recommended as the first choice. However, the curative effect did not increase despite course of the treatment prolonged. The healing rate and effective rate after 1 course was 52.21% （59/113） and 92.04% （104/113）, that after 2 courses 58.41% （66/113） and 95.58% （108/113）, that after 3 courses 59.29% （67/113） and 95.58% （108/113）. The healing rate in different course did not present differences （P 〉 0.05）. 21 patients undergoing surgery were followed-up, 12 patients were after 2 years and 9 patients were between 1 - 2 years. The healing rate was 95.24% （20/21）, 1 case was healed basically, the effective rate was 100%. None reoccurred. Conclusions There are characterized features in clinical epidemiology of the brucell spondylitis. Long term, adequate in dosage, combination and multi-approach use of antibiotics is the most reliable way to treat and prevent it from r

关 键 词：布鲁杆菌病 脊柱炎 流行病学 治疗效果 

分 类 号：R686[医药卫生—骨科学]