神经型布鲁菌病的临床特点及诊治分析

目的探讨神经型布鲁菌病的临床特点、诊断标准及抗菌药物联合治疗方案。 方法回顾性分析首都医科大学附属北京地坛医院2008年9月至2014年7月收治的10例神经型布鲁菌病患者的临床资料。 结果神经型布鲁菌病以青壮年男性为主,均有明确的流行病学史,临床多表现为脑膜炎和脑膜脑炎等。所有患者血清布鲁杆菌凝集试验阳性,6例患者行脑脊液布鲁杆菌凝集试验,其中4例阳性。所有患者均行腰椎穿刺检查,7例患者脑脊液压力升高,9例白细胞数升高（以单核细胞升高为主）,9例患者蛋白升高,5例糖减低。全部病例给予多西环素和利福平基础上联合三代头孢、氨基糖苷类、复方新诺明、喹诺酮类中的一种或两种组成三联或四联初始抗病原治疗,序贯长疗程口服抗菌药物,平均疗程> 6个月。 结论神经型布鲁氏菌病的临床表现复杂多样,大部分患者预后良好,少数患者可留有后遗症。治疗上不同药理学机制的抗菌药物联合、足量、长疗程治疗有效。     

布鲁菌性脊柱炎26例临床分析

布鲁菌病（brucellosis）是由布鲁菌引起的人畜共患传染性疾病。该病传染性强,传播范围广,是一种全身性疾病,可对多器官产生影响。布鲁菌可经消化道、皮肤黏膜、呼吸道等多种途径侵入人体而引起感染或致病。该病的临床症状主要为发热、多汗、全身乏力及关节疼痛等,侵袭脊柱时可引发脊柱炎。布鲁菌性脊柱炎（brucellarspondylitis）是布鲁菌病在骨关节系统的表现之一,据统计在布鲁菌病中约占10．4％。现结合我院近3年收治的26例布鲁菌性脊柱炎进行分析。     

抗布鲁菌病治疗致急性肾损伤2例分析并文献复习

<正>布鲁菌病(brucellosis,布病),也称波状热,是布鲁菌引起的急性或慢性传染病,属自然疫源性疾病,临床上主要表现为病情轻重不一的发热、多汗、关节痛等。利福平(RFP)600~900 mg/d联合四环素200 mg/d,疗程6周,为世界卫生组织推荐的治疗方案[1]。抗布鲁菌病药物治疗过程中,主要的不良反应包括消化道反应、肝损害,而鲜有急性肾损伤的病例报道。近期我科收治了2例抗布鲁菌病药物导致急性肾损伤(acute     

微创手术治疗18例布鲁菌病髋关节炎合并早期股骨头坏死的疗效

目的 探讨微创手术治疗布鲁菌病髋关节炎合并早期股骨头坏死的疗效.方法 回顾性分析首都医科大学附属北京地坛医院骨科2012年11月至2016年3月收治的18例布鲁菌病髋关节炎合并早期股骨头坏死患者,术前采用四联抗布鲁菌病药物(多西环素+利福平+左氧氟沙星+头孢曲松钠)治疗2～3个疗程后,局部症状仍缓解欠佳,最后行微创手术...     

布鲁杆菌病性脊椎炎的临床影像学表现及外科治疗

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。     

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。     

浙江省中部地区布鲁菌病六例临床分析

布鲁菌病是由布鲁菌引起的人畜共患性传染病,又称地中海弛张热、马尔他热、波浪热或波状热,属自然疫源性疾病,主要以牛、羊、猪为传染源,人主要是接触病畜而感染。布鲁菌病临床表现复杂,病情轻重不一,可侵犯全身多个系统,常表现为发热、乏力、多汗、关节痛、肝脾肿大等,但症状缺乏典型性。该病一般在内蒙古等北方牧区流行,南方地区很少有该病流行。我们分析了浙江省金华市6例布鲁菌病的流行病学、临床特征、治疗等情况,旨在提高对该病的认识。     

布鲁杆菌性脊柱炎4例诊疗体会

正布鲁杆菌病是由布鲁杆菌引起的一种人畜共患的传染病,又称马耳他热、波状热及地中海弛张热等[1]。当布鲁杆菌引发椎间盘感染时称为布鲁杆菌性脊柱炎[2],临床较少见,而处于沿海地区的广东则更加少见,易造成临床误诊。本院2013年2月—2014年10月收治布鲁杆菌性脊柱炎患者4例,均经影像学及实验室检查确认,经药物治疗疗效满意。现将本病的诊疗过程报告如下。1临床资料     

布鲁杆菌病性脊椎炎的影像学分型及临床意义

背景：布鲁杆菌病性脊椎炎的发病率正逐渐升高,而其影像学分型有利于该病的标准化治疗及疗效评价。 目的：探讨布鲁杆菌病性脊椎炎的影像学分型及其临床意义。 方法：回顾分析2008年1月至2012年7月经临床及实验室检查确诊为布鲁杆菌病性脊椎炎的89例患者的影像学资料,依据X线、CT及MR影像学表现对患者进行分型。 结果：布鲁杆菌病性脊椎炎的影像学分Ⅰ-Ⅴ型。Ⅰ型：椎体炎型,Ⅱ型：椎间盘炎型,Ⅲ型：骨膜炎型,Ⅳ型：椎旁脓肿或腰大肌脓肿型,Ⅴ型：脊髓神经型。两型以上为复合型。本组46例为复合型（51.69%）,其中Ⅴ型伴有其他4种类型最多（45例）;43例为单纯型（48.31%）,其中Ⅰ型20例、Ⅱ型9例、Ⅲ型4例、Ⅳ型6例、Ⅴ型4例。31例通过非手术治愈,58例采用手术治疗,其中52例行病灶清除术、6例行经皮微创术治疗。本组89例均随访1年,痊愈83例,好转6例,愈后无复发。 结论：布鲁杆菌病性脊椎炎影像学分型对临床诊治策略的制定具有参考价值及指导意义。     

布鲁杆菌病脊柱炎的治疗进展

布鲁杆菌病（Brucellosis,简称布病）是由布鲁杆菌引起的一种人畜共患的系统性变态反应性传染病。布鲁杆菌病易侵袭骨与关节引起感染性病变,当侵袭椎间盘引发椎间隙感染时称为布鲁杆菌病感染性脊柱炎或布鲁杆菌病脊柱炎,     

布鲁氏杆菌性脊柱炎的诊治体会

【摘要】〓目的〓探讨布鲁氏杆菌性脊柱炎的诊断及治疗疗效。方法〓选择云峰医院2009年~2012年诊治的布鲁氏杆菌性脊柱炎患者18例,病变部位包括T₁₂-L₁:3例,L₁:2例,L_2-3:4例,L_3-4:4例,L_3-5:2例,L₅-S₁:2例,L₄-S₁:1例。18例患者中,保守治疗5例,使用多西四环素、利福平、链霉素联合用药;手术治疗13例,采取腰椎前路或后路病灶清除、髂骨取骨内固定。术后随访2年。结果〓全部患者均获得满意效果。保守治疗5例中有2例在剧烈劳动后会出现轻微下腰痛;手术患者植骨均融合,其中前路手术组有1例患者偶有午后低热、乏力;后路手术组中有1例患者残留轻微下腰痛伴有不同程度下肢不适。结论〓布鲁氏杆菌性脊柱炎通过合理选择治疗方案,单纯药物和药物联合手术均可取得满意疗效。     

Brucellar breast abscess

Brucellosis is an endemic disease seen in many countries. It may affect different organ systems. Brucellar breast abscess is a rare entity. We report the radiological findings of breast abscess due to brucella. A 63-year-old female was investigated with mammography, ultrasonography, magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS). A mass measuring 25 x 20 x 15 mm was detected in the left breast on mammography and ultrasonography. The mass was homogenously hyperintense on T1- and T2-weighted MRI images. On contrast-enhanced T1-weighted images, peripheral capsular enhancement was found. MR spectroscopic analysis of the mass revealed elevated lipid and acetate peaks. The diagnosis was provided by fine needle aspiration biopsy and specimen culture. The lesion had diminished in size after 12 months' treatment with combined tetracycline and rifampicine.     

Brucellosis of the spine – A global public health problem - An analysis of 37 patients from a ‘high risk’ region

BackgroundBrucellosis is a global public health issue. Brucellosis of the spine presents as a wide spectrum. The aim was to present the outcome analysis of patients treated for Spinal Brucellosis in the endemic region. Secondly to assess the accuracy of IgG and IgM Elisa in the diagnosis.ResultsA retrospective study of all patients who were treated for Brucellosis of the spine from 2010 to 2020 was conducted. Confirmed cases of Brucellosis of spine and who had adequate follow up after completion of treatment were included. The outcome analysis was based on clinical, laboratory and radiological parameters. There were 37 patients enrolled with a mean age of 45 and an average follow up of 24 months. All of them presented with pain and 30% had neurological deficits. Surgical intervention was done in 24%(9/37patients). All the patients were treated with triple drug regimen for an average duration of 6 months. Those patients with relapse had a 14month period of triple drug regimen. The sensitivity and specificity of IgM was 50% and 85.71%. The sensitivity and specificity of IgG was 81.82% and 7.69%.76% of them had good functional outcome and 82% of them had near normal neurological recovery and 97.3%(36 patients) were healed of the disease with relapse in one patient(2.7%).ConclusionsMajority (76%) of the patients with Brucellosis of the spine were treated conservatively. Average duration of treatment of triple drug regimen was 6 months. The sensitivity of IgM & IgG was 50% and 81.82% The specificity of IgM and IgG was 85.71% and 7.69% respectively.     

Non-operative management of osteoarthritis of the knee joint

Osteoarthritis is a chronic disorder of synovial joints in which there is progressive softening and disintegration of articular cartilage accompanied by the growth of osteophytes. Treatment designed for osteoarthritis should aim at reducing pain, improve joint mobility, and limit functional impairment. It can be achieved by pharmacological and non-pharmacological means. Non-operative treatment of OA is useful for patients with KL grade 1–3, which are early stages of OA. However, in an advanced stage of OA (KL grade 4), surgical treatment is needed as definitive treatment.     

Primary osteoarthritis of the elbow: current treatment options

In the elbow, as in other joints, primary osteoarthritis is characterized by pain, stiffness, mechanical symptoms, and weakness. But primary osteoarthritis of the elbow is unique in that there is relative preservation of articular cartilage and maintenance of joint space, with hypertrophic osteophyte formation and capsular contracture. Medical treatment and physical therapy may be initiated in the early stages of the disease process. Surgical treatment options include arthroscopic osteocapsular débridement, open ulnohumeral arthroplasty, distraction interposition arthroplasty, and total elbow arthroplasty. The potential for instability and loosening following total elbow arthroplasty in the setting of primary osteoarthritis limits the clinical application of this procedure. This patient population is generally younger than that recommended for total elbow arthroplasty, and their higher functional demands have limited the long-term success of this treatment option. The improvement in arthroscopic débridement techniques is perhaps the greatest advancement in the treatment of osteoarthritis of the elbow in recent years.     

布鲁杆菌性脊柱炎31例临床诊治分析

目的 分析布鲁杆菌性脊柱炎(brucellar spondylitis,BS)的临床诊断及疗效.方法 选择我院2010年1月至2013年5月诊治的BS患者31例,记录患者临床症状与体征,行红细胞沉降率(ESR)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、血清凝集试验等实验室检查,并行X线、MRI检查.所有患者给予多西环素、利福平、链霉素联合药物治疗,其中保守药物治疗27例,联合手术治疗4例(其中1例为保守治疗无效后行手术治疗),采取腰椎后路植骨内固定+前路病灶清除植骨融合术.治疗后复查以上检查指标,并评判治疗效果.结果 术后随访平均13个月,无临床复发,全部患者均获得满意效果.保守治疗患者于标准抗菌治疗后2～7 d内腰痛症状缓解.结论 通过标准抗菌治疗及必要时联合手术治疗BS疗效满意.     

H型血管铁死亡对骨质疏松性骨关节炎的影响及调节机制研究

随着全社会人口老龄化的加剧,绝经后女性罹患骨质疏松性骨关节炎的风险亦呈现高发趋势,严重危害中老年人的健康。研究证实血管形成及功能异常是加剧骨质疏松、骨关节炎病理退变的重要事件。H型血管(内皮细胞)在骨与软骨损伤修复中兼具成骨和成血管偶联功能,其形态与功能异常将影响骨质疏松、骨关节炎的损伤修复。铁死亡作为近年来发现的一种新型细胞死亡模式,其主要由铁依赖性脂质过氧化和活性氧诱导损伤引起细胞膜断裂,线粒体变小等改变。而H型血管铁死亡对骨质疏松性骨关节炎病程的影响途径及调节机制尚需进一步探讨,旨在为今后以H型血管铁死亡为切入点进而防治骨质疏松性骨关节炎开辟新方向。     

Ligament Injury, Reconstruction and Osteoarthritis

PURPOSE OF REVIEW: The recent literature on the factors that initiate and accelerate the progression of osteoarthritis following ligament injuries and their treatment is reviewed. RECENT FINDINGS: The ligament-injured joint is at high risk for osteoarthritis. Current conservative (e.g. rehabilitation) and surgical (e.g. reconstruction) treatment options appear not to reduce osteoarthritis following ligament injury. The extent of osteoarthritis does not appear dependent on which joint is affected, or the presence of damage to other tissues within the joint. Mechanical instability is the likely initiator of osteoarthritis in the ligament-injured patient. SUMMARY: The mechanism osteoarthritis begins with the injury rendering the joint unstable. The instability increases the sliding between the joint surfaces and reduces the efficiency of the muscles, factors that alter joint contact mechanics. The load distribution in the cartilage and underlying bone is disrupted, causing wear and increasing shear, which eventually leads to the osteochondral degeneration. The catalyst to the mechanical process is the inflammation response induced by the injury and sustained during healing. In contrast, the inflammation could be responsible for onset, while the mechanical factors accelerate progression. The mechanisms leading to osteoarthritis following ligament injury have not been fully established. A better understanding of these mechanisms should lead to alternative surgical, drug, and tissue-engineering treatment options, which could eliminate osteoarthritis in these patients. Progress is being made on all fronts. Considering that osteoarthritis is likely to occur despite current treatment options, the best solution may be prevention.     

Femoroazetabuläres Impingement bei Sportlern

Femoroacetabular impingement (FAI) and its therapy has gained importance in the last decade and several studies could show that if untreated it may lead to osteoarthritis of the hip joint. In this article an overview of the pathology of FAI, the diagnosis and treatment options are presented. A closer look is taken at the treatment of elite athletes regarding the different techniques. The first own clinical and radiological results of 91 patients treated by the arthroscopically-assisted anterior mini-open approach are presented with very good results and significant postoperative improvement regarding the hip injury and osteoarthritis outcome score (HOOS), the Western Ontario and McMasters University (WOMAC) osteoarthritis index and the University of California Los Angeles (UCLA) activity score, as well as alpha angle correction. This technique which is poorly represented in the literature can be used as a treatment option for FAI. The rehabilitation program is comparable to hip arthroscopy.     

Association of photobiomodulation therapy (PBMT) and exercises programs in pain and functional capacity of patients with knee osteoarthritis (KOA): a systematic review of randomized trials

Lasers in Medical Science - Knee osteoarthritis (KOA) is a common degenerative disease in which several treatments and treatment associations have been investigated. This review analyzed the...