布氏杆菌性脊柱炎临床影像学表现及外科治疗

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1、布氏杆菌性脊柱炎临床影像学表现及外科治疗作者：杨新明，石蔚,杜雅坤，孟宪勇,邹宇纬,杨峰，刘肃，李化光【摘要】［目的］探讨布氏杆菌性脊椎炎的临床表现、影像学特点与外科治疗，以便提高该病的临床诊断和治疗水平。［方法］本组16例均行X线摄片并行CT检查，病灶分布腰椎多于胸椎，其中L4发病率最高，其中7例行MRI检查；16例血清试管凝集法滴度均大于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，11例作病原学检查。［结果］14例入院前临床、X线及CT误诊为脊柱结核，误诊率87.5％；经MRI扫描误诊5例，

2、误诊率71.43％；本组16例入院确诊后，在药物治疗基础上，2例采取介入方法，7例采取手术病灶清除，病理符合布氏杆菌性脊椎炎的细胞学表现。本组仅12例（包括手术8例）进行随访1～2年，痊愈10例，好转2例，愈后无复发。［结论］布氏杆菌性脊椎炎临床与影像学具有特征性表现；正确选择微创术和手术病灶清除术可以缩短疗程，减少并发症，提高治愈率；无论手术还是非手术治疗，长期、足量、联合、多途径敏感抗生素的应用是治疗和防止本病复发的最主要和最可靠方法。【关键词】布鲁氏菌病；脊柱炎；诊断影像学；临床15Abstract：［Objective］Toi

3、mprovetheclinicaldiagnosisandtherapiceffectandtodiscusstheclinicalandimageologicmanifestationsandtreatmentofthebrucellosisspondylitis(BS).［Method］SixteenpatientswithBSwerealltakenradiographsandCTscanningandsevencaseswerealsotakenMRI.ThetestofSAT,testofRBPandELISAwereuse

4、dinaccessingBS.Pathogenicbacteriawereexaminedin11cases.Allcasesweretreatedwithantibrucellosisagentsandotherconservativemeasures.Sevencaseswerefollowedwithafocaldebridementand2caseswithminimalinvasivesurgery.［Result］FourteencasesweremisdiagnosedasspineTBbeforetheywereho

5、spitalizedwithrateoferrordiagnosis87.5%,evencarefulclinicandradiographicexamination,andCTscanninghadbeentaken,and5casesweremisdiagnosedbyMRIwiththemisdiagnosisrate71.4%.TheBSoccurredfarmoreinthelumbarvertebraethaninthethoracicvertebraewithitshighestmorbidityattheL4.Amon

6、g16cases,thetitersofSATtestwereallbeyond1.160,thetestofRBPallshowedpositiveandIgG,IgMshowedpositivebyELISA.ElevencaseswasconfirmedBSdiagnosisbyphthogenicbacteriaexamination.Only12caseswerefollowedupfor1～2years(including8surgicaltreatedcases).Tencaseswerecured15withoutr

7、ecurrence,and2casesimproved.［Conclusion］Brucellosisspondylitiscommonlymisdiagnosebeforehospitalization.Characteristicimageologicchangesandclinicalappearance,combinedtestsofSATandRBPareusefulfordiagnosis.Longtermandenoughamountsensitiveantibioticsandotherconservativemea

8、suresisstillthemajorandreliablemeasuresintreatmentofBSandpreventrecurrence,additionalminimalinvasivesurgeryorf