实用骨科杂志
實用骨科雜誌
실용골과잡지
Journal of Practical Orthopaedics
2015年
9期
774-779
,共6页
闫斌%杨新明%孟宪勇%胡长波%任义行
閆斌%楊新明%孟憲勇%鬍長波%任義行
염빈%양신명%맹헌용%호장파%임의행
布鲁氏杆菌病%脊柱炎%诊断%外科治疗%临床评价
佈魯氏桿菌病%脊柱炎%診斷%外科治療%臨床評價
포로씨간균병%척주염%진단%외과치료%림상평개
brucelliasis%spondylitis%diagnosis%surgical treatment%clinical evaluation
目的：探讨布鲁氏杆菌病性脊柱炎的诊断和外科综合治疗的临床效果。方法2008年1月至2013年1月收治93例布鲁氏杆菌性脊柱炎患者，其中男59例，女34例；年龄21~65岁，平均（46.52±1.27）岁。通过流行病学史、临床表现、影像学检查、实验室及病理学检查确诊，其中22例患者具有非手术指证采用强力霉素+利福平+磺胺甲基异唑药物治疗（ A组），71例患者（颈椎6例、腰椎65例）具有手术指证在药物治疗基础上采用病灶清除植骨内固定术，治疗后3、6、12个月进行临床疗效评价。采用SPSS 15.0统计软件进行分析。结果93例患者治疗后3个月随访率100%，6个月随访率A组86.36%、B组91.54%，12个月随访率A组77.27%、B组83.09%，末次随访时所有患者无药物不良反应及肝肾功能异常发生，手术患者切口愈合好，无断钉、断棒病例，颈椎和腰椎手术植骨均愈合，无植骨并发症，脊柱稳定。随着时间推移，各组治愈率均逐渐提高，6个月、12个月时间点与3个月时间点比较，差异均有统计学意义（P﹤0.05），但同一个时间点两组治愈率比较，差异均无统计学意义（P﹥0.05）。结论依据流行病学史、临床表现、影像学特点、实验室检查容易作出诊断及鉴别诊断，长期、足量、联合敏感抗生素的应用是治疗和防止本病复发最主要和最可靠的方法，只要正确掌握非手术和手术指证均可以治愈病灶，提高临床疗效。
目的：探討佈魯氏桿菌病性脊柱炎的診斷和外科綜閤治療的臨床效果。方法2008年1月至2013年1月收治93例佈魯氏桿菌性脊柱炎患者，其中男59例，女34例；年齡21~65歲，平均（46.52±1.27）歲。通過流行病學史、臨床錶現、影像學檢查、實驗室及病理學檢查確診，其中22例患者具有非手術指證採用彊力黴素+利福平+磺胺甲基異唑藥物治療（ A組），71例患者（頸椎6例、腰椎65例）具有手術指證在藥物治療基礎上採用病竈清除植骨內固定術，治療後3、6、12箇月進行臨床療效評價。採用SPSS 15.0統計軟件進行分析。結果93例患者治療後3箇月隨訪率100%，6箇月隨訪率A組86.36%、B組91.54%，12箇月隨訪率A組77.27%、B組83.09%，末次隨訪時所有患者無藥物不良反應及肝腎功能異常髮生，手術患者切口愈閤好，無斷釘、斷棒病例，頸椎和腰椎手術植骨均愈閤，無植骨併髮癥，脊柱穩定。隨著時間推移，各組治愈率均逐漸提高，6箇月、12箇月時間點與3箇月時間點比較，差異均有統計學意義（P﹤0.05），但同一箇時間點兩組治愈率比較，差異均無統計學意義（P﹥0.05）。結論依據流行病學史、臨床錶現、影像學特點、實驗室檢查容易作齣診斷及鑒彆診斷，長期、足量、聯閤敏感抗生素的應用是治療和防止本病複髮最主要和最可靠的方法，隻要正確掌握非手術和手術指證均可以治愈病竈，提高臨床療效。
목적：탐토포로씨간균병성척주염적진단화외과종합치료적림상효과。방법2008년1월지2013년1월수치93례포로씨간균성척주염환자，기중남59례，녀34례；년령21~65세，평균（46.52±1.27）세。통과류행병학사、림상표현、영상학검사、실험실급병이학검사학진，기중22례환자구유비수술지증채용강력매소+리복평+광알갑기이서약물치료（ A조），71례환자（경추6례、요추65례）구유수술지증재약물치료기출상채용병조청제식골내고정술，치료후3、6、12개월진행림상료효평개。채용SPSS 15.0통계연건진행분석。결과93례환자치료후3개월수방솔100%，6개월수방솔A조86.36%、B조91.54%，12개월수방솔A조77.27%、B조83.09%，말차수방시소유환자무약물불량반응급간신공능이상발생，수술환자절구유합호，무단정、단봉병례，경추화요추수술식골균유합，무식골병발증，척주은정。수착시간추이，각조치유솔균축점제고，6개월、12개월시간점여3개월시간점비교，차이균유통계학의의（P﹤0.05），단동일개시간점량조치유솔비교，차이균무통계학의의（P﹥0.05）。결론의거류행병학사、림상표현、영상학특점、실험실검사용역작출진단급감별진단，장기、족량、연합민감항생소적응용시치료화방지본병복발최주요화최가고적방법，지요정학장악비수술화수술지증균가이치유병조，제고림상료효。
Objective To investigate the diagnosis and clinical effects of surgical treatment for brucella spondylitis. Methods Based on the evidences from epidemiological history,clinical manifestations,imaging,laboratory and pathology,93 cases of Brucella spondylitis patients were diagnosed and treated in our hospital from January 2008 to January 2013. 22 cases of patients with non-surgical indications were treated with doxycycline,rifampicin and sulfamethoxazole(A group),71 cases(6 cases of cervical spondylitis,65 cases of lumbar spondlylitis)with surgical indications underwent debridement and autograft with internal fixation on the basis of drug therapy. Clinical effects were assessed at 3,6 and 12 months after treatments and u-sing SPSS 15. 0 statistical software for analysis. Results 3-month follow-up rate of 93 cases was 100%,6-month follow-up rate in group A was 8 6 . 3 6%,group B was 9 1 . 5 4%,1 2 - month follow - up rate in group A was 7 7 . 2 7% ,group B was 83. 09%. Last follow-up showed that all patients were in good conditions. There were no adverse drug reactions and liver and kidney dysfunction. No broken nails or broken rods cases. Surgical incisions healed well. Cervical and lumbar spine bone healed without bone graft complications. The cure rates in all groups were gradually improved. Differences were statistically significant ( P﹤0. 05)compared the cure rates at 3,6 and 12 months,but at the same time point,the difference was not statistically signif-icant between two groups(P﹥ 0. 05). Conclusion Brucella spondylitis is easy to make a diagnosis and differential diagnosis based on epidemiological history,clinical manifestations,imaging features and laboratory tests. A long-term,adequate,joint sensitive antibiotics are the most important and most reliable method to prevent recurrence of the disease. The correct threapy according to non-surgical and surgical indications can heal lesions and improve clinical outcomes.
