CAJ | 학술논문

目的探讨老年布鲁杆菌脊椎炎临床特点、治疗方法及疗效. 方法 2002年1月至2013年5月收治45例老年布鲁杆菌脊椎炎患者,入院前均误诊为脊柱结核,入院后经病史、临床表现、实验室检查、影像学检查以及病理学检查进行综合诊断.所有患者均行规范化药物治疗及高压氧辅助治疗,其中19例非手术治疗(非手术组),26例一期病灶清除联合后路椎弓根内固定手术治疗(手术组).本组患者治疗后均行随访和疼痛评分、实验室检测、影像学评分及临床疗效评价. 结果治疗后12个月随访,非手术组治愈17例,改善2例,无药物不良反应及肝肾功能异常发生;手术组26例,治愈24例,改善2例,植骨均愈合,脊柱稳定,无断钉、断棒、复发及窦道形成.疼痛评分显示,随着时间延长,两组治疗方法均可使疼痛评分值逐渐降低即有效的缓解疼痛,但手术组无论在时间上还是在解除疼痛效果方面均优于非手术组(P＜0.05).手术组比非手术组治疗早期使血清试管凝集试验(SAT)滴度、C反应蛋白(CRP)较治疗前降低和虎红平板凝集试验(RBPT)阴性.随着时间推移非手术组治疗方法可使椎体炎症浸润和椎间隙感染逐渐吸收,但疗程长,且在时间和影像学改变方面无手术组效果明显(P＜0.05).两组治疗方法均有较好的效果,但手术组早期治愈率优于非手术组(P＜0.05). 结论老年布鲁杆菌脊椎炎诊断标准的制定有助于提高诊断率,减少误诊率,规范化药物治疗具有较好的治愈率,适时手术干预可提高临床疗效,特别是解除疼痛、稳定脊柱、恢复神经功能,促进早期康复均具有优越性.
목적 탐토노년포로간균척추염림상특점、치료방법급료효. 방법 2002년1월지2013년5월수치45례노년포로간균척추염환자,입원전균오진위척주결핵,입원후경병사、림상표현、실험실검사、영상학검사이급병이학검사진행종합진단.소유환자균행규범화약물치료급고압양보조치료,기중19례비수술치료(비수술조),26례일기병조청제연합후로추궁근내고정수술치료(수술조).본조환자치료후균행수방화동통평분、실험실검측、영상학평분급림상료효평개. 결과 치료후12개월수방,비수술조치유17례,개선2례,무약물불량반응급간신공능이상발생;수술조26례,치유24례,개선2례,식골균유합,척주은정,무단정、단봉、복발급두도형성.동통평분현시,수착시간연장,량조치료방법균가사동통평분치축점강저즉유효적완해동통,단수술조무론재시간상환시재해제동통효과방면균우우비수술조(P＜0.05).수술조비비수술조치료조기사혈청시관응집시험(SAT)적도、C반응단백(CRP)교치료전강저화호홍평판응집시험(RBPT)음성.수착시간추이비수술조치료방법가사추체염증침윤화추간극감염축점흡수,단료정장,차재시간화영상학개변방면무수술조효과명현(P＜0.05).량조치료방법균유교호적효과,단수술조조기치유솔우우비수술조(P＜0.05). 결론 노년포로간균척추염진단표준적제정유조우제고진단솔,감소오진솔,규범화약물치료구유교호적치유솔,괄시수술간예가제고림상료효,특별시해제동통、은정척주、회복신경공능,촉진조기강복균구유우월성.
Objective To discuss the clinical features and treatment of Brucella spondylitis in elderly people and its efficacy.Methods From January 2002 to May 2013,45 cases of elderly patients with Brucella spondylitis who were misdiagnosed as spinal tuberculosis before admission were diagnosed synthetically by epidemiological history,clinical manifestations,laboratory tests,medical imaging and pathological data after admission.All patients were treated by standardized drug treatment and hyperbaric oxygen therapy,of which 19 cases were treated by non-surgical treatment (group A) and 26 cases were treated by the operation of primary debridement and posterior pedicle screw fixation (group B).All patients underwent follow-up,pain score,laboratory testing,imaging score and clinical efficacy evaluation after the operation.Results During 12 months follow-up after treatment,17 cases were cured,2 cases improved ; no adverse drug reaction and abnormal liver and kidney function were found in group A.26 cases in group B underwent operation,of which 24 cases were cured,2 cases improved.The implanted bone was healed,the spine was stable and no broken nails,broken rod,recurrence and sinus formation were found in group B.Both of the treatments could gradually decrease pain score that relieved pain effectively over time.The time for pain-relieving and the pain-relieving efficacy were less or better in group B than in group A (both P＜0.05).The time for decreasing the serum agglutination test (SAT) titre and C-reactive protein (CRP) level,and for becoming negative of Rose Bengal Plane Test (RBPT) was less in group B than in group A.The vertebral inflammatory infiltration and infection of intervertebral space were gradually absorbed,which required a longer period of treatment in group A,and the efficacies in imaging changes at different time were less in group A than in group B (all P＜0.05).The early-stage cure rate was better in group B than in group A,although both treatments had obvious effect (P＜ 0.05).Conclusions The formulation of the diagnostic criteria of Brucella spondylitis in elderly people can improve the diagnostic rate and reduce the misdiagnosis rate.Standardized drug treatment has a better cure rate,and timely surgical intervention can improve clinical effect and has significant advantages particularly in relieving pain,stabilizing the spine,restoring nerve function and promoting early rehabilitation.