老年人布鲁杆菌脊椎炎患者的临床报道  

Clinical report of Brucella spondylitis in elderly people

作　　者：杨新明[1] 石蔚[1] 张磊[3] 杜雅坤[4] 任义行 孟宪勇[1] 胡长波[1] 贾永利[1] 王耀一[1] 

机构地区：[1]河北北方学院附属第一医院,张家口075000 [2]河北北方学院研究生部外科学系 [3]河北医科大学第四医院 [4]河北省儿童医院

出　　处：《中华老年医学杂志》2015年第2期175-180,共6页Chinese Journal of Geriatrics

基　　金：河北省医学重点学科跟踪项目（GL201321）;河北省省级重大医学科研课题（zd2013049）;河北省医学重点学科跟踪项目（GL201469）.

摘　　要：目的探讨老年布鲁杆菌脊椎炎临床特点、治疗方法及疗效。方法2002年1月至2013年5月收治45例老年布鲁杆菌脊椎炎患者，人院前均误诊为脊柱结核，人院后经病史、临床表现、实验室检查、影像学检查以及病理学检查进行综合诊断。所有患者均行规范化药物治疗及高压氧辅助治疗，其中19例非手术治疗（非手术组），26例一期病灶清除联合后路椎弓根内固定手术治疗（手术组）。本组患者治疗后均行随访和疼痛评分、实验室检测、影像学评分及临床疗效评价。结果治疗后12个月随访，非手术组治愈17例，改善2例，无药物不良反应及肝肾功能异常发生；手术组26例，治愈24例，改善2例，植骨均愈合，脊柱稳定，无断钉、断棒、复发及窦道形成。疼痛评分显示，随着时间延长，两组治疗方法均可使疼痛评分值逐渐降低即有效的缓解疼痛，但手术组无论在时间上还是在解除疼痛效果方面均优于非手术组（P〈O．05）。手术组比非手术组治疗早期使血清试管凝集试验（SAT）滴度、C反应蛋白（CRP）较治疗前降低和虎红平板凝集试验（RBPT）阴性。随着时间推移非手术组治疗方法可使椎体炎症浸润和椎间隙感染逐渐吸收，但疗程长，且在时间和影像学改变方面无手术组效果明显（P〈0．05）。两组治疗方法均有较好的效果，但手术组早期治愈率优于非手术组（P〈O．05）。结论老年布鲁杆菌脊椎炎诊断标准的制定有助于提高诊断率，减少误诊率，规范化药物治疗具有较好的治愈率，适时手术干预可提高临床疗效，特别是解除疼痛、稳定脊柱、恢复神经功能，促进早期康复均具有优越性。Objective To discuss the clinical features and treatment of Brucella spondylitis in elderly people and its efficacy. Methods From January 2002 to May 2013, 45 cases of elderly patients with Brucella spondylitis who were misdiagnosed as spinal tuberculosis before admission were diagnosed synthetically by epidemiological history, clinical manifestations, laboratory tests, medical imaging and pathological data after admission. All patients were treated by standardized drug treatment and hyperbaric oxygen therapy, of which 19 cases were treated by non-surgical treatment （group A） and 26 cases were treated by the operation of primary debridement and posterior pedicle screw fixation （group B）. All patients underwent follow-up, pain score, laboratory testing, imaging score and clinical efficacy evaluation after the operation. Results During 12 months follow-up after treatment, 17 cases were cured, 2 cases improved ; no adverse drug reaction and abnormal liver and kidney function were found in group A. 26 cases in group B underwent operation, of which 24 cases were cured, 2 cases improved. The implanted bone was healed, the spine was stable and no broken nails, broken rod, recurrence and sinus formation were found in group B. Both of the treatments could gradually decrease pain score that relieved pain effectively over time. The time for pain-relieving andthe pain-relieving efficacy were less or better in group B than in group A （both P〈0.05）. The time for decreasing the serum agglutination test （SAT） titre and C-reactive protein （CRP） level, and for becoming negative of Rose Bengal Plane Test （RBPT） was less in group B than in group A. The vertebral inflammatory infiltration and infection of intervertebral space were gradually absorbed, which required a longer period of treatment in group A, and the efficacies in imaging changes at different time were less in group A than in group B （all P〈0.05）. The early-stage cure rate was better in group B than in group A, although both treatments had

关 键 词：布鲁杆菌病 脊柱 炎症 

分 类 号：R687.3[医药卫生—骨科学]