布鲁氏菌性脊柱炎临床诊断体系和影像学分型标准建立的临床意义  

Establishment of clinical diagnostic system and imaging classification standard for brucello spondylitis and its clinical significance

作　　者：杨新明[1] 杨超伟 姚尧 田野 陈丽星 YANG Xinming;YANG Chaowei;YAO Yao;TIAN Ye;CHEN Lixing(Department of Orthopaedics,The 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

出　　处：《中华骨与关节外科杂志》2023年第2期122-130,共9页Chinese Journal of Bone and Joint Surgery

基　　金：河北省政府资助省级临床医学优秀人才项目(361009);河北省卫生健康技术研究暨成果转化重点项目(zh2018014);河北省医学适用技术跟踪项目(G2018074,GZ2022068);河北省医学科学研究课题计划(20200504);2021年市级科技计划自筹经费项目(2121058D)。

摘　　要：目的:建立布鲁氏菌性脊柱炎(BS)临床诊断体系及影像学分型标准,以提高诊断率,并为患者实施正确的治疗。方法:2008年1月至2021年3月收治BS患者116例,包括初次就诊于外院时被误诊的102例,其中91.2%(93/102)被误诊为脊柱结核。按照临床诊断体系对患者进行流行病史调查,进行临床、影像、实验室、病原学和病理学的规范化检查。确诊后初次用药首选多西环素+利福平+磺胺甲唑,依据影像学分型标准分为非手术治疗组42例,手术治疗组74例;两组患者治疗后3、6、12个月进行随访,应用多参数临床疗效评价指标进行评价。结果:116例患者入院后均经临床诊断体系诊断为BS。非手术治疗组患者依据体质、体重、营养状况、肝肾功能、药敏试验结果、药代动力学、耐药基因检测实施个体化药物治疗;手术治疗组患者在个体化药物治疗基础上依据影像学分型标准实施个性化手术治疗。治疗后3、6、12个月进行随访及评价,两组患者均为出现并发症、复发及肝肾功能损害,手术治疗组患者切口愈合良好,无脱钉断钉现象,椎间植骨融合良好,脊柱稳定;两组患者随着时间的延长,治愈率均逐渐提高。结论:BS临床诊断体系及影像学分型标准的建立有助于提高诊断率;依据患者个体差异和影像学分型标准制定个性化的药物治疗或手术治疗方案,只要适应证选择正确,并掌握正确的手术实施时机(指患者入院后的营养状况、血糖、血压、心肺肝肾功能、下肢深静脉血栓等各项指标经过调整,可以耐受手术),可以提高临床治愈率。Objective:To establish the clinical diagnosis system and imaging classification standard of brucella spondylitis(BS)in order to improve the diagnosis rate of the disease,and to assist for suitable treatment for the patients.Methods:From January 2008 to March 2021,116 BS patients were admitted to our hospital,including 102 patients misdiagnosed in other hospitals on their first admission with the misdiagnosis rate of 91.2%(93/102)as spinal tuberculosis.After admission,according to the clinical diagnostic system,all patients received epidemiological survey and clinical,imaging,laboratory,etiological and pathological examinations.After diagnosis,doxycycline+rifampicin+sulfamethoxazole were chosen as the first medication.According to the imaging classification standard,all patients were classified into two groups as surgical treatment group(n=74)and non-surgical treatment group(n=42).All patients were followed up at 3,6,12 months after the operation,and multiple indicators were used to evaluate the efficacy.Results:After comprehensive examination by standardized diagnostic system,116 patients were diagnosed as BS.The patients in non-surgical treatment group received individualized drug treatment based on patients’constitution,weight,nutritional status,liver and kidney function,drug sensitivity results,pharmacokinetics and drug resistance gene detection,and the patients in surgical treatment group received individualized surgery based on individualized drug treatment according to imaging classification standard.No complications,recurrence or liver and kidney function injuries were found in all patients during the follow-up period.The incision healing of the patients in surgical treatment group was good,and there was no broken screw or off screw.The intervertebral bone graft fusion was good,and the spine was stable.With the prolongation of time,the cure rates in both groups were gradually improved.Conclusions:The establishment of BS clinical diagnostic system and imaging classification standard is helpful to improve

关 键 词：布鲁氏菌病 脊椎炎 诊断体系 分型 个体化治疗 临床疗效 

分 类 号：R516.7[医药卫生—内科学] R681.5[医药卫生—临床医学]