布鲁菌病性脊柱炎的临床特点及手术治疗效果分析  

Clinical characteristics and surgical treatment effect of Brucellar spondylitis

作　　者：杨新明[1] 石蔚[2] 杜雅坤[3] 张磊[4] 孟钊[5] Yang Xinming;Shi Wei;Du Yakun;Zhang Lei;Meng Zhao(Department of Orthopaedics,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of Pediatric,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of Neurology,the Children's Hospital of Hebei Province,Shijiazhuang 050031,China;Department of Neurosurgery,the Fourth Affiliated Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Orthopaedics,the Children's Hospital of Hebei Province,Shijiazhuang 050031,China)

机构地区：[1]河北北方学院附属第一医院骨外科,张家口075000 [2]河北北方学院附属第一医院儿科,张家口075000 [3]河北省儿童医院神经内科,石家庄050031 [4]河北医科大学第四医院神经外科,石家庄050011 [5]河北省儿童医院骨科,石家庄050031

出　　处：《中华地方病学杂志》2019年第4期320-324,共5页Chinese Journal of Endemiology

基　　金：2018年河北省卫生健康技术研究暨成果转化重点项目(zh2018014);2018年河北省医学适用技术跟踪项目(G2018074);2017年张家口市市级科技计划(17120010D);2018年河北北方学院校级科研项目(YB2018010).

摘　　要：目的分析布鲁菌病(简称布病)性脊柱炎临床特点,评价其手术治疗效果。方法采用资料回顾性方法,收集2002-2015年河北北方学院附属第一医院确诊及采取手术治疗的年龄≥65岁老年布病性脊柱炎患者临床资料,分析患者的临床表现及特征、实验室诊断、影像学改变和手术治疗效果。并根据术后12个月内的随访资料,对患者进行疼痛和影像学评分以及临床疗效评价。结果共收集38例老年布病性脊柱炎患者临床资料,就诊时主要临床症状和体征为持续性剧烈腰背痛,局部压痛,叩击痛明显,肌肉痉挛,脊柱活动受限。虎红平板凝集试验(RBPT)阳性11例,试管凝集试验(SAT)滴度在1∶100以上28例,术中取炎性肉芽肿或脓肿布鲁菌培养阳性28例。手术前,X线检查显示,有29例椎间隙狭窄,密度增高,椎体边缘骨质破坏;有9例椎体缘骨质硬化增生呈鸟嘴状,与相邻椎体缘形成骨桥。CT检查显示,有29例椎体边缘有大小不等多发破坏灶,病灶周围增生硬化,新生骨组织中又有破坏灶构成"花边椎";有9例椎间盘破坏呈等密度影,关节面增生硬化的骨质形成"唇"状骨赘;有10例同时伴有椎体破坏平面的两侧腰大肌增宽,其内有脓肿形成。磁共振成像(MRI)检查显示,全部患者椎体、椎间盘、附件及椎管内呈不均匀高信号,相应平面硬脊膜或神经根受压。术后2周及1、3、6、12个月疼痛评分[(2.1±0.2)、(0.7±0.4)、(0.2±0.1)、(0.0±0.0)、(0.0±0.0)分]明显低于术前[(9.2±0.3)分,P均<0.05];术后3、6、12个月影像学盲测评分[(4.68±0.04)、(4.92±0.08)、(5.00±0.00)分]明显高于术前[(0.37±0.03)分,P均<0.05];术后6、12个月临床疗效评价治愈率[92.11%(35/38),100.00%(38/38)]明显高于术后3个月[78.95%(30/38),P均<0.05)]。结论老年布病性脊柱炎具有典型的影像学特征,实验室检查有助于早期诊断。适时手术治疗有利于解除疼痛、稳定脊柱功能和加速布病Objective To analyze the clinical characteristics of Brucellar spondylitis and evaluate its surgical treatment effect.Methods From 2002 to 2015,the clinical data of diagnosed patients with Brucellar spondylitis aged ≥65 years old were collected retrospectively in the First Affiliated Hospital of Hebei North University,patients'clinical manifestations and characteristics,laboratory diagnosis,imaging changes and surgical treatment effects were analyzed.Pain and imaging scores and clinical efficacy were evaluated according to follow-up data within 12 months after surgery.Results A total of 38 cases of senile patients with Brucellar spondylitis were studied.The main clinical symptoms during the visit were persistent severe lumbar back pain,local tenderness,obvious percussion pain,muscle spasm,and constrained movements of spine.Rose bengal plate test(RBPT)was positive in 11 cases,serum tube agglutination test(SAT)titer was higher than 1 ∶ 100 in 28 cases.During the operation,28 cases of patients with inflammatory granuloma or abscess were cultured positive for Brucella.Before surgery,manifestations of X-ray:of which 29 cases showed intervertebral space narrowing,the density increased,and the margins of the verbebral bodies destructed;of which 9 cases showed vertebral body bone sclerosing hyperplasia in the shape of a bird's beak,forming a bone bridge with the adjacent vertebral body margin.Manifestations of CT:of which 29 cases showed different sizes and multiple lesions of the vertebral body margin,and hyperplasia and sclerosis around the lesion,and destruction of the lesion in the new bone tissue to form "lacy vertebra";in 9 cases,the destruction of intervertebral discs showed isodensity shadow,and the hyperplasia and sclerosis of articular surface resulted in the formation of "labial" osteophytes;of which 10 cases showed vertebral body destroyed the plane in which the bilateral psoas were widened and abscess formed.Manifestations of MRI:of which 38 cases showed that the vertebral bodies,intervertebral discs,acc

关 键 词：布鲁杆菌病 脊柱炎 外科手术 疗效 临床评价 

分 类 号：R516.7[医药卫生—内科学]