布鲁氏杆菌脊柱炎的外科治疗  

Surgical treatment of brucellosis spondylitis

作　　者：魏奇峰[1] 马克[1] 黄志刚[1] WEI Qifeng;MA Ke;HUANG Zhigang(Department of Orthopedics,Shenzhen Third People＇s Hospital,Shenzhen 518021,China)

机构地区：[1]深圳市第三人民医院骨外科,广东深圳518021

出　　处：《中国现代医生》2018年第18期1-4,7,共5页China Modern Doctor

摘　　要：目的介绍布鲁氏杆菌性脊柱炎治疗中脊柱外科手术干预治疗技术的新进展,并探讨其可行性和安全性。方法回顾性分析我院2009年1月~2017年6月收治的布鲁氏杆菌性脊柱炎患者33例的临床资料,其中包括19例患者在术前经正规、联合、有效药物治疗约2~4周,症状及各项感染指标好转后,在脊柱外科行多种组合式手术治疗,其包括病灶清除、椎管减压、植骨融合、内固定及VSD引流术。结果手术治疗19例患者入院完善相关CT、MRI等影像学检查,血清菌培养阳性,疾控中心ELISA检测之IgM阳性而获确诊,在药物对症与联合抗菌治疗基础上,7例患者采取微创单纯病灶清除方法,12例患者采取手术病灶清除及植骨融合、后路内固定技术,其中5例先行采取VSD持续引流技术。患者共33例进行随访1~3年,痊愈31例(包括手术患者痊愈19例),好转2例。结论在明确诊断布鲁氏杆菌性脊柱炎后,部分疗效欠佳的患者在有效抗菌治疗基础上,正确选择微创手术、后路内固定手术或VSD持续引流手术等多种组合式手术干预治疗,可以缩短疗程,提高治愈率及早期明显改善患者生活质量。Objective To introduce the new progress of spinal surgical intervention in the treatment of brucellosis spondylitis, and to explore its feasibility and safety. Methods The clinical data of 33 patients with brucellosis spondylitis who were admitted to our hospital from January 2009 to June 2017 were retrospectively analyzed. Of these, 19 patients were treated with regular, combined, and effective medications for about 2-4 weeks before surgery. After symptoms and various indices of infections were improved, a variety of combined surgical treatments in spinal surgery were conducted, including lesion removal, spinal decompression, bone graft fusion, internal fixation and VSD drainage technique. Results 19 patients receiving surgical treatment were given CT, MRI and other imaging examinations upon admission. The serum culture of bacteria was positive. The ELISA detection in the disease control center showed IgM positive and then confirmed diagnosis. Based on drug symptomatic therapy and combined antibacterial therapy, 7 pa- tients were treated with minimally invasive method for removal of lesions. 12 patients were given removal of surgical lesions, bone graft fusion, and posterior internal fixation. Among them, 5 patients were first given VSD continuous drainage technology. A total of 33 patients were followed up for 1 to 3 years, among whom 31 patients were cured （in- cluding 19 patients recovered from surgery）, and 2 patients were improved. Conclusion After confirming the diagnosis of brucellosis spondylitis, some patients with poor efficacy have correctly selected multiple combined procedures such as minimally invasive surgery, posterior internal fixation, or VSD continuous drainage surgery on the basis of effective antimicrobial therapy, which can shorten the course of treatment, improve the cure rate and significantly improve the quality of life of patients at early times.

关 键 词：布鲁氏杆菌 脊椎炎 脊柱手术 组合式手术 

分 类 号：R687.3[医药卫生—骨科学]