CAJ | 학술논문

目的探讨布鲁杆菌病性脊柱炎的临床、实验室、影像学特点及手术疗效.方法 2000年9月至2010年12月共手术治疗布鲁杆菌病性脊柱炎患者27例,男18例,女9例；年龄23～57岁,平均32.8岁.颈椎3例,胸腰椎8例,腰骶椎16例.17例以“脊柱结核”收治,2例以“腰椎间盘突出症术后”收治.根据患者的临床、影像学及血清学检查等,明确诊断为布鲁杆菌病性脊柱炎.8例行后路病灶清除、自体骨植骨内固定术；19例采用前路病灶清除,自体骨植骨内固定术.24例术中病灶局部放置链霉素粉剂(余3例链霉素皮试阳性).术后支具外固定4～6周,口服药物1.5～3.0个月.临床疗效评价包括临床治愈率、疼痛视觉模拟评分及植骨融合率.结果 27例均获得随访,随访时间6个月～4年,平均19.7个月.根据布鲁杆菌病性脊柱炎疗效评定标准:痊愈24例,有效3例.3例腰椎病变者因切口渗出、窦道形成,给予清创缝合或病灶清除内固定调整术后痊愈,愈后无复发.结论颈、胸、腰背部疼痛伴间歇性波浪热,结合影像学检查和特异性的血清凝集试验阳性可确诊布鲁杆菌病性脊柱炎.对于顽固腰痛保守治疗无效,椎体、椎间盘严重破坏造成椎体间不稳,脊髓、神经根受压,或伴较大难以吸收的椎旁脓肿或腰大肌脓肿者,彻底的病灶清除、自体骨植骨内固定手术,联合抗菌药物治疗是安全、有效的方法.
목적 탐토포로간균병성척주염적림상、실험실、영상학특점급수술료효.방법 2000년9월지2010년12월공수술치료포로간균병성척주염환자27례,남18례,녀9례；년령23～57세,평균32.8세.경추3례,흉요추8례,요저추16례.17례이“척주결핵”수치,2례이“요추간반돌출증술후”수치.근거환자적림상、영상학급혈청학검사등,명학진단위포로간균병성척주염.8례행후로병조청제、자체골식골내고정술；19례채용전로병조청제,자체골식골내고정술.24례술중병조국부방치련매소분제(여3례련매소피시양성).술후지구외고정4～6주,구복약물1.5～3.0개월.림상료효평개포괄림상치유솔、동통시각모의평분급식골융합솔.결과 27례균획득수방,수방시간6개월～4년,평균19.7개월.근거포로간균병성척주염료효평정표준:전유24례,유효3례.3례요추병변자인절구삼출、두도형성,급여청창봉합혹병조청제내고정조정술후전유,유후무복발.결론 경、흉、요배부동통반간헐성파랑열,결합영상학검사화특이성적혈청응집시험양성가학진포로간균병성척주염.대우완고요통보수치료무효,추체、추간반엄중파배조성추체간불은,척수、신경근수압,혹반교대난이흡수적추방농종혹요대기농종자,철저적병조청제、자체골식골내고정수술,연합항균약물치료시안전、유효적방법.
Objective To study the clinical,laboratory,imaging characteristics and surgical outcomes of Brucellar spondylitis.Methods The clinical,laboratory,imaging characteristics and surgical outcomes of 27 patients with Brucella spondylitis were analyzed in our department from September 2000 to December 2010.There were 18 males and 9 females,aged from 23 to 57 years(average,32.8 years ).There were 3 cases in cervical vertebra,8 cases in thoracolumbar vertebra,16 cases in lumbosacral vertebra respectively.Before admission,17 patients were misdiagnosed as tuberculosis,2 ones were as postoperative change of lumbar disc herniation.Eight patients underwent posterior debridement,autologous bone grafting and instrumentation,19 cases were treated with anterior debridement,autologous bone grafting and instrumentation.Streptomycin was placed in localized lesions for 24 patients,except for 3 cases whose streptomycin skin test positive.External fixation brace were used for 4 to 6 weeks,oral medication was used for a half month to 3 months.Clinical evaluation included clinical cure rate,pain visual analog scale (VAS) and the fusion rate.Results All of 27 patients were followed up for an average of 19.7 months (range,6 to 48 months).According to evaluation standard for Brucella spondylitis,24 patients were cured,3 patients got improvement.Three patients underwent the second operation owing to wound infection and sinus formation.Conclusion The pain of spine with intermittent fever,the imaging features as well as positive serum agglutination test can confirm the diagnosis of Brucellar spondylitis.Operation should be considered in patients with persistent pain and neurologic disorders as well as systemic symptoms.Instrumentation is effective and safe in the treatment of patients with spinal brucellosis following debridement,autogenous bone grafting,combined with antibiotic therapy.