CAJ | 학술논문

目的探讨布鲁杆菌病性脊椎炎的临床表现、影像学特点与外科治疗方法.方法对21例布鲁杆菌病性脊椎炎患者进行临床、实验室和影像学检查,并采用药物、经皮置管引流和手术病灶清除术进行治疗.结果病灶多分布于腰椎,L4发病率最高.21例血清试管凝集法检查滴度均大于1∶160,虎红平板凝集试验阳性,酶联免疫吸附试验检查特异性抗体IgM、IgG阳性,14例病原学检查阳性.18例患者入院前临床、X线及CT检查均误诊为脊柱结核,误诊率85.71%;经MR检查误诊8例,误诊率66.67%.14例患者经药物治疗无效,5例采用经皮置管引流术,9例采用手术病灶清除术治疗,病理均符合布鲁杆菌病性脊椎炎的细胞学表现.17例患者获得随访,随访时间1～2年,痊愈15例,好转2例,愈后无复发.结论布鲁杆菌病性脊椎炎临床与影像学具有特征性表现.无论是非手术还是手术治疗,长期、足量、联合、多途径敏感抗生素的应用是治疗和防治布鲁杆菌病性脊椎炎复发的最主要和最可靠方法.对具有手术指征者,正确选择手术方法可以控制病变部位发展,缓解疼痛,减少并发症.
목적 탐토포로간균병성척추염적림상표현、영상학특점여외과치료방법.방법 대21례포로간균병성척추염환자진행림상、실험실화영상학검사,병채용약물、경피치관인류화수술병조청제술진행치료.결과 병조다분포우요추,L4발병솔최고.21례혈청시관응집법검사적도균대우1∶160,호홍평판응집시험양성,매련면역흡부시험검사특이성항체IgM、IgG양성,14례병원학검사양성.18례환자입원전림상、X선급CT검사균오진위척주결핵,오진솔85.71%;경MR검사오진8례,오진솔66.67%.14례환자경약물치료무효,5례채용경피치관인류술,9례채용수술병조청제술치료,병리균부합포로간균병성척추염적세포학표현.17례환자획득수방,수방시간1～2년,전유15례,호전2례,유후무복발.결론 포로간균병성척추염림상여영상학구유특정성표현.무론시비수술환시수술치료,장기、족량、연합、다도경민감항생소적응용시치료화방치포로간균병성척추염복발적최주요화최가고방법.대구유수술지정자,정학선택수술방법가이공제병변부위발전,완해동통,감소병발증.
Objective To improve the diagnostic and therapic level of brucellar spondylitis,the clinical characteristics and surgical treatment of the disease were discussed.Methods Twenty-one patients with brucellar spondylitis were retrospectively evaluated in terms of their clinical,laboratory,and radiologic features and their response to different treatment regimens.Results Twenty-one patients with brucellar spondylitis were examined by X-ray and CT scanning.Twelve patients were studied by MRI.Brucellar spondylitis involve more often in the lumbar vertebrae.The fourth lumbar vertebra was the most frequently Rose bengal plate test were positive and the specific antibodies of the germ,as IgM and IgG were found by enzyme-linked immunosorbent assay in all of these patients.Brucella species was isolated from blood cultures in 14 patients.18 cases were misdiagnosed as the spine tuberculosis before hospitalization,even having been underwent the clinical examination,X-ray and CT scanning.The rate of misdiagnosis was 85.71%;8patients who measured by MRI were misdiagnosed,and the rate of misdiagnosis was 66.67%.After the 21patients were diagnosed as brucellar spondylitis,antibiotics regimen were used.5 patients were treated with percutaneous drainage,and the clearance of focal lesion was performed in 9 patients.The diagnosis of the disease was confirmed by pathological examination.In these 21 cases,17 cases were followed up for 1-2vears,15 cases healed,2 cases relieved and none recurred.Conclusion Brucellar spondylitis has specific changes in clinical and radiologic features.The patients can be treated effectively with appropriate antibiotic combinations.Surgery is considered as the last resort in treating spinal brucellosis.If the indications are respected,the minimal invasive surgery or the focus removal surgery can shorten the course of therapy,relieved pain,and decrease complications.