腰椎布鲁杆菌病性脊椎炎的诊断与治疗

目的探讨腰椎布鲁杆菌病性脊椎炎的诊断与治疗。方法将2003年1月至2012年12月本科室收治的36例腰椎布鲁杆菌病性脊椎炎患者进行流行病学、临床、影像学、实验室和病理学检查，并采用药物和手术病灶清除术进行治疗。对治疗后3、6和12个月临床疗效进行评价。采用SPSS15．0统计软件包进行分析。结果本组36例患者入院前行腰椎X线、CT及MRI检查均被误诊，其中32例被X线和CT误诊为脊柱结核，误诊率为88．88％；24例MRI误诊为脊柱结核，误诊率为66．66％。所有患者入院后经流行病调查均有布鲁杆菌病流行病学史，临床表现符合感染性脊柱炎，实验室检查RBPT或SAT、CFT、Coomb’s阳性，CT及MRI影像学具有特征性表现，病原学检查结果显示7例阳性，11例组织活检镜下符合布鲁杆菌病病理学表现。入组患者中20例（A组）选择药物治疗，其余16例（B组）伴有马尾、神经根受压症状、腰椎不稳定和腰大肌或椎旁脓肿者行手术治疗。本组36例均获随访，随访时间为12～24个月，平均18个月；20例非手术治疗者全身症状和局部症状消失或改善明显，疗效好，无药物不良反应及肝肾功能异常发生；16例手术患者关节突间和（或）横突问植骨均愈合，脊柱稳定，无复发。临床疗效评价显示各组后1个时间点的治愈率与前1个时间点比较差异具有统计学意义（p〈0．05），且在相同时间点A组和B组治愈率比较，差异均具有统计学意义（x^2=159．874，P〈0．05）。结论腰椎布鲁杆菌病性脊椎炎的流行病学、临床症状、影像学、检验学及病理学具有特征性表现，可作出早期诊断和鉴别诊断。正确的掌握非手术和手术治疗适应证均可取得较好的临床疗效。

Diagnosis and treatment of lumbar brucellosis spondylitis

Objective To investigate the diagnosis and treatment of lumbar brucellosis spondylitis. Methods From January 2003 to December 2012, total of 36 cases of patients with brucella spondylitis were checked up by epidemiology, clinical medicine, imageology, laboratory and pathology, and treated by medicine and the surgery of focus of infection clearing, respectively. After treatment for 3, 6 and 12 months, the clinical efficacy was evaluated, respectively. The data were analyzed by SPSS 15.0 software. Results The group of 36 hospitalized patients were misdiagnosed by lumbar X-ray, CT and MRI, among which 32 cases were misdiagnosed by X-ray and CT as tuberculosis, with the misdiagnosis rate of 88.88%. There were 24 cases MRI misdiagnosed as tuberculosis, with the misdiagnosis rate of 66.66%. All of the patients were certified with the epidemiological history of brucella disease after the survey, the clinical manifestations were consistent with infectious spondylitis, the laboratory tests of RBPT or SAT, CFT, Coomb＇s were positive and the CT and MR] imaging were distinctive. There were 7 cases with positive after the etiology examination and 11 cases of brucellosis were consistent with the pathologic manifestations after the microscopic examination. The 20 cases in group A were treated by medicine, and the other 16 cases in group B with cauda equina nerve root compression symptoms, lumbar instability or paraspinal and psoas abscess were treated by surgery. Total of 36 patients were followed up for 12 to 24 months, with an average of 18 months. There were 20 cases of non-surgical treatment of systemic symptoms and local symptoms disappeared or improved significantly, efficacy, adverse drug reactions and no abnormal kidney fimction. Among the 16 cases of surgical patients facet and/or posterolateral graft healed, spinal stabilization, without recurrence. Clinical evaluation of the cure rate and display a point in time before the difference after a point in time in each group was statistically significant （P 〈 0.05）