布鲁杆菌性脊柱炎与脊柱结核的鉴别诊断与治疗  

Differential diagnosis and treatment of brucella spondylitis and spinal tuberculosis

作　　者：丁惠强[1] 原文琦 Ding Huiqiang;Yuan Wenqi(Department of Spine Surgery,General Hospital of Ningxia Medical University,Yinchuan 750000,China)

机构地区：[1]宁夏医科大学总医院脊柱骨科,银川750000

出　　处：《中华骨科杂志》2021年第20期1484-1492,共9页Chinese Journal of Orthopaedics

基　　金：宁夏回族自治区重点研发计划(2018BEG03028)。

摘　　要：布鲁杆菌性脊柱炎与脊柱结核是脊柱外科常见的两种特异性感染性疾病。两种疾病在临床表现和影像学表现有许多相似之处。临床表现均有疼痛、发热、多汗、厌食等症状,当炎症累及椎间隙、椎间盘或存在硬膜外脓肿时可压迫神经,致使相应神经支配区域出现疼痛、麻木、感觉障碍以及肌力下降等,严重时可引起瘫痪;早期影像学表现均为受累椎体破坏,椎间隙变窄或消失,可形成椎旁脓肿,因此,极易发生误诊。从临床表现、影像学特点、实验室检查和组织病理学检查等方面对布鲁杆菌性脊柱炎和脊柱结核的诊断进行对比和总结,以提供临床上进行鉴别诊断的要点。在此基础上,从药物治疗和手术治疗两个方面对布鲁杆菌性脊柱炎与脊柱结核的治疗原则及手术指征进行总结和探讨,旨在进一步提高临床上对布鲁杆菌性脊柱炎与脊柱结核的诊疗效果。Brucella spondylitis and spinal tuberculosis are two common specific infectious diseases in spine surgery.They have many similar manifestations in clinical manifestations and imaging features.Clinically,there are symptoms such as pain,fever,hyperhidrosis,and anorexia.When inflammation involves the intervertebral space,intervertebral disc,or epidural abscess,it can cause nerve compression,resulting in pain,numbness,sensory disturbances,and decreased muscle strength in the corresponding innervated areas.And even in severe cases it can cause paralysis.The early imaging of both showed bone destruction of the involved vertebral body,narrowing or disappearance of the intervertebral space,and the formation of paravertebral abscesses.Therefore,it is very easy to cause misdiagnosis.This article compares and summarizes the diagnosis of brucellosis spondylitis and spinal tuberculosis from four aspects:clinical manifestations,imaging characteristics,and laboratory examinations and histopathological examinations.Based on the above,the treatment principles and surgical indications of the two diseases were summarized and discussed from the aspects of drug treatment and surgical treatment,with an aim to further improve the clinical diagnosis and treatment of the two diseases.

关 键 词：脊柱结核 感觉障碍 椎间隙变窄 硬膜外脓肿 脊柱外科 诊疗效果 椎旁脓肿 神经支配 

分 类 号：R681.51[医药卫生—骨科学] R529.2[医药卫生—外科学]