腰椎布鲁杆菌性脊柱炎的临床诊疗策略  

The clinical diagnosis and treatment strategy of lumbar brucellar spondylitis

作　　者：秦一川 王永峰[1] 原杰 徐朝健[1] 赵斌[1] Qin Yichuan;Wang Yongfeng;Yuan Jie;Xu Chaojian;Zhao Bin(Department of Orthopaedics,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院骨科,太原030001

出　　处：《中华骨科杂志》2021年第20期1476-1483,共8页Chinese Journal of Orthopaedics

基　　金：山西省自然科学基金(201801D121220)。

摘　　要：腰椎布鲁杆菌性脊柱炎是布鲁杆菌侵袭腰椎所引起的感染性疾病,近年来发病率呈上升趋势,严重威胁着人们的健康。早期、恰当地诊疗是腰椎布鲁杆菌性脊柱炎患者治愈的关键。但该病早期仅有腰背痛、午后高热、大汗等非特异征象,如患者出现上述症状,流行病学有直接或间接牲畜接触史,且MRI可见椎体或椎间隙炎性浸润,则应考虑腰椎布鲁杆菌性脊柱炎早期感染的可能。中晚期综合流行病学、临床症状、体征及实验室检查,结合腰椎病变椎间隙变窄,椎体和椎间盘信号异常,骨质破坏及硬化,"花边椎",可见死骨和局限性椎旁脓肿等影像学表现,对该病做出诊断并不困难。但此期患者往往因骨质破坏出现腰椎不稳等严重表现,重点在于手术干预。手术治疗以病灶清除+固定为基本原则,术中减少脊柱后方韧带复合体等骨与韧带结构的损伤并给予坚强固定,将有助于该病的彻底治愈。通过检索腰椎布鲁杆菌性脊柱炎的相关文献,着重从病原学、发病机制、临床表现、各期影像学特征、实验室检查及保守与手术治疗等方面对该疾病进行阐述,旨在为临床诊疗提供依据。Lumbar brucellar spondylitis is an infectious disease caused by the invasion of brucella.The incidence has been on the rise in recent years.And it threatens people's health seriously.Early and proper diagnosis and treatment is the key to cure patients with lumbar brucella spondylitis.However,in the early stage of the disease,there are only nonspecific symptoms such as back pain,fever,and sweating.If the patient has the above symptoms and epidemiological history of direct or indirect livestock contact,and inflammatory signals of the vertebrae or intervertebral space are visible on MRI,the possibility of early infection of lumbar brucella spondylitis should be considered.It is not difficult to make the diagnosis of lumbar brucella spondylitis in the middle and late stages by taking into account the epidemiology,symptoms,signs,laboratory tests,and the imaging features such as narrowing of the intervertebral space,abnormal signals of the vertebral body and disc,bone destruction and sclerosis,"lace-like"appearance,sequestrum formation and limited paraspinal abscess.Patients in these stages often present with serious manifestations such as lumbar instability due to bone destruction,and the focus is on surgical intervention.The basic principle of surgical treatment is lesion removal combined with fixation.Intraoperative reduction of damage to bone and ligamentous structures such as the posterior ligamentous complex and strong fixation will contribute to the complete cure of the disease.By referring to the literature on lumbar brucellar spondylitis,this paper focuses on the etiology,pathogenesis,clinical manifestations,imaging features,laboratory tests and conservative and surgical treatment of the disease,aiming to provide a basis for clinical diagnosis and treatment.

关 键 词：骨质破坏 炎性浸润 病灶清除 腰椎病变 信号异常 腰背痛 流行病学 死骨 

分 类 号：R687.3[医药卫生—骨科学]