21例布氏杆菌性脊柱炎的诊断及综合治疗疗效观察  

The diagnosis and curative effect observation of the comprehensive treatment of brucella spondylitis in 21 cases

作　　者：张俊荣[1] 裴东红[1] 师晓峰[1] 白卫国[1] 余慧平 李进龙[1] 白皓[1] 高军红[1] 白旭东[1] 

机构地区：[1]榆林市第一医院骨二科,718000

出　　处：《中国骨与关节杂志》2012年第1期54-59,共6页Chinese Journal of Bone and Joint

摘　　要：目的探讨布氏杆菌性脊柱炎临床表现及影像学特点,以提高对该病的鉴别诊断水平。观察药物与手术综合治疗的效果。方法回顾性分析我科收治21例布氏杆菌性脊柱炎患者的临床表现、体征、影像学特点、实验室及病理检查等情况。采用利福平和四环素及链霉素联合药物治疗的同时,均采取一期病灶清除植骨融合术,其中3例加内固定治疗。结果 (1)21例均有与羊、羊皮、羊肉接触史。本组病例均有发热,多为典型波浪热。腰部疼痛7例,脊柱,四肢大关节及肌肉痛14例,经治疗后均遗有位置固定的腰痛;均有乏力,多汗,食欲减退,消瘦。(2)布氏杆菌性脊柱炎病灶除1例为T_(11-12)余均分布于腰椎。骨破坏灶小而多发,多局限于椎体边缘。病灶周围明显硬化、增生,新生,骨组织中有新破坏灶形成。椎间隙变窄较结核轻,少或无椎旁脓肿形成,无死骨形成。(3)化验布氏杆菌试管凝集试验均为阳性。虎红平板凝集试验15例+++、4例++、2例+。血沉增快21例,为35～110mm/h。(4)超声检查见肝脾肿大6例,腹腔间隙积液3例,(5)病灶清除后均留标本送病理检查符合布氏杆菌性脊柱炎之诊断。(6)对初治6例和复治15例均采用利福平、四环素,链霉素药物治疗的同时行病灶清除植骨融合或植骨融合内固定术,术后疼痛即刻缓减,2周疼痛消失,血沉开始下降。2～3个疗程血沉恢复正常,布氏杆菌试管凝集试验和虎红平板凝集试验转为阴性。结论布氏菌杆性脊柱炎可以通过接触史、典型的临床表现、影像特点、特殊的实验室检查及病理检查明确诊断,采用利福平、四环素、链霉素联合治疗的同时手术综合治疗可以取得满意的效果。Objective To investigate the clinical manifestations and imaging characteristics of brucella spondylitis and to improve the differential diagnosis of this disease. To watch the effects of comprehensive pharmaceutical and surgical therapy. Methods 21 cases with brucella spondylitis were absorbed in our department and their clinical manifestations, physical signs, imaging characteristics, results of laboratory research, pathological examinations and so on were retrospectively analyzed. Together with the joint drug treatment of rifampicin, tetracycline and streptomycin, primary debridement and bone graft fusion were taken. 3 cases among 21 cases were added with internal fixation. Results a： All 21 cases had contact history with sheep, sheepskin and mutton. They all had fever early, and most showed typical heat waves. Back pain appeared in 7 cases. Pain in the spine, large joints of limbs and muscles appeared in 14 cases. After therapy, back pain was relieved. Weakness, hidrosis, anorexia and marasmus appeared in all cases, b： Except that 1 case was in T1H2, lesions of brucella spondylitis in the other cases all located in lumbar vertebrae. Bone destructive lesions were small but multiple, and most were confined on the vertebral edge. Obvious hardening and hyperplasia existed around lesions. New destructive lesions formed in new bone tissues, which made intervertenral space become narrow, but wider than tuberculosis could do. There was little or no paravertebral abscess formation and no sequestrum formation, c： In brucellosis tube agglutination test, all cases were positive. In rose bengal precipitation test, 15 cases were of ＋＋＋, 4 cases were ＋＋ and 2 cases were ＋. The erythrocyte sedimentation rate increased in 21 cases, being 35-110mm/h. d： Hepatosplenomegaly in ultrasonic testing appeared in 6 cases, and effusion in celiac clearance appeared in 3 cases, e： When lesions were cleared away, all the specimens reserved were sent for pathologic examination, and all met the diagnosis of brucella sp

关 键 词：布氏杆菌 脊柱炎 诊断 药物治疗 手术治疗 

分 类 号：R687.3[医药卫生—骨科学]