布氏杆菌性脊柱炎的规范化诊断及外科标准化治疗  

Diagnostic and surgical treatment of Brucella spondylitis

作　　者：杨新明[1] 孟宪勇[1] 胡长波[1] 张振梁[2] 康聪[2] 成垚昱 YANG Xinming MENG Xianyong HU Changb ZHANG Zhenliang KANG Cong CHENG Yaoyu(Department of Orthopaedics Surgery to Graduate School, First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei, China)

机构地区：[1]河北北方学院附属第一医院骨科,河北张家口075000 [2]河北北方学院附属第一医院,河北张家口075000

出　　处：《中国骨与关节外科》2016年第4期308-316,共9页Chinese Journal of Bone and Joint Surgery

基　　金：2013年河北省省级重大医学科研课题(zd2013049);2014年河北省医学重点学科跟踪项目(GL2014069);2015年河北省政府资助临床医学优秀人才培养和基础课题研究项目(361009)

摘　　要：背景：布氏杆菌性脊柱炎的误诊率较高,掌握规范化诊断方法及标准化外科治疗可以提高治愈率、降低复发率。目的：探讨布氏杆菌性脊柱炎的规范化诊断和外科治疗方法。方法：2008年1月至2014年5月收治108例布氏杆菌性脊柱炎患者,男65例,女43例,年龄21-65岁,平均（43.4±1.3）岁。病程时间3-29个月,平均（6.4±1.6）个月。发病部位：颈椎7例,胸椎10例,胸腰椎3例,腰椎62例,腰骶椎26例。32例入院即明确诊断,65例以＂脊柱结核＂入院,11例以＂化脓性脊椎炎＂入院,入院后均行流行病学调查和临床、影像学、实验室及病理学检查得到确诊。32例采用强力霉素＋利福平＋磺胺甲基异噁唑即单纯药物治疗（A组）;76例在药物治疗基础上采用病灶清除植骨内固定术（B组）,其中32例采用短节段病椎置钉固定。治疗后3、6、12个月进行临床疗效评价。结果：术中病理检查结果符合布氏杆菌病的组织学表现。108例患者治疗后3个月的随访率为100%,6个月随访率A组为81.25%、B组为88.15%,12个月随访率A组为75.00%、B组为80.26%。末次随访时无一例发生药物不良反应及肝肾功能异常。A组2例患者经药物治疗全身症状好转,但脊柱病变部位症状加重而行手术治疗,术后1年均治愈。B组患者切口均Ⅰ期愈合,无复发及窦道形成,无断钉、断棒病例,植骨均愈合,融合时间为7-11个月,平均（8.4±1.2）个月,无植骨并发症,脊柱稳定。61例患者于术后18-24个月要求取出脊柱内固定,其中32例为短节段病椎置钉固定,术中经椎弓根钉孔取椎体骨组织行病理学检查,肉眼及镜下均未见炎性表现。两组患者术后6、12个月的治愈率均较术后3个月时有明显提高（P〈0.05）,但各时间点两组患者的治愈率比较均无统计学差异（P〉0.05）。结论：布氏杆菌性脊柱炎的流行病学、临床表现、影像学、实验室及病理学均有特征�Background：Misdiagnosis rate of Brucella spondylitis is very high.Standardizing diagnosis and surgical treatment may help improve clinical cure rate and reduce recurrence rate.Objective：To investigate the standardized diagnosis and surgical treatment for Brucella spondylitis.Methods：Based on the epidemiological history,clinical manifestations,imaging,laboratory and pathology,108 patients were diagnosed as Brucella spondylitis and hospitalized from January 2008 to May 2014.There were 65 males and 43 females with an average age of（43.4±1.3）years（ranging from 21 to 65 years）.The infection occurred in the cervical vertebrae in 7 cases,in thoracic vertebrae in 10,in thoracolumbar vertebrae in 3,in lumbar vertebrae in 62 and in lumbosacral vertebrae in 26.Before admission,65 patients were misdiagnosed as tuberculosis and 11 were misdiagnosed as suppurative spondylitis.Of them,32 were treated with doxycycline,rifampicin and sulfamethoxazole（group A）,and 76 were treated with debridement and autograft with internal fixation on the basis of drug therapy（group B）.Clinical effects were assessed at 3,6 and 12 months after treatments.Results：The diagnosis was confirmed by intraoperative pathological examination.Three-month follow-up rate of the 108 cases was 100%.Six-month follow-up rate was81.25%in group A and 88.15%in group B.Twelve-month follow-up rate was 75%in group A and 80.26%in group B.At the last follow-up,no adverse drug reactions or hepatorenal dysfunction occurred,surgical incisions healed well,and no broken nails or broken rods cases were found.General symptoms were improved after drug treatment while spinal lesion deteriorated in 2 patients of group A who underwent surgery and healed 12 months later.All the cases in group B achieved bone healing and stable spine with no correlated complication,and the average healing time was（8.4±1.2） months（range,7-11months）.The internal nutlocking devices were taken out from 61 patients including 32 cases of short-segment pedicle internal fixat

关 键 词：布氏杆菌病 脊柱炎 诊断 外科治疗 

分 类 号：R687.3[医药卫生—骨科学]