MRI影像分型对布鲁杆菌病性脊椎炎的诊断与治疗价值

目的 探讨MRI影像分型对布鲁杆菌病性脊椎炎(BS)的诊断与治疗价值。方法 回顾性分析2002年1月—2013年7月确诊且符合纳入标准的257例BS患者的临床资料,其中男131例,女126例,年龄21～82岁,平均(46.52±1.27)岁。依据发病部位、椎体及椎间隙炎症浸润和破坏程度、椎旁软组织改变、脊柱的稳定性、脊髓或马尾、神经根受压等MRI影像表现对病例进行分型。采用非手术和手术治疗,前者为单纯药物治疗(A组),后者分为腰椎局限性病灶微创术(B组)、颈椎病灶清除植骨内固定术(C组)、胸腰椎病灶清除植骨术(D组)和胸腰椎病灶清除植骨内固定术(E组)。通过影像分析一致性检验及临床疗效判定标准对影像分型与临床治疗策略两者之间的相关性进行评价。结果 本组257例中,MRI影像分型为Ⅰ型47例、Ⅱ型45例、Ⅲ型41例、Ⅳ型32例、Ⅴ型92例;2个椎体受累241例、3个椎体受累16例,以腰椎发病率最高(65.36%,168/257)。治疗后3个月257例均得到复查;6个月212例(82.49%)得到复查,其中手术134例、非手术78例,A组5例复发(腰椎Ⅱ型1例、Ⅲ型2例、Ⅳ型2例)、B组2例复发(腰椎Ⅱ型1例、Ⅳ型1例),复发7例均改为E组治疗方案治愈;12个月173例(67.31%)得到复查,其中手术112例、非手术61例,各组均无复发病例。C、E组无论术后早期还是后期脊柱均稳定,且植骨均愈合;D组56例中50例采用横突关节突间植骨术,19例(38%)植骨愈合且脊柱稳定,31例(62%)植骨吸收(其中16例伴有脊柱不稳及下腰痛,再次行E组治疗方案后植骨融合脊柱稳定)。影像分析一致性检验κ值均>0.75;临床疗效显示各组后一个时间点与前一个时间点治愈率比较差异均有统计学意义(P值均＜0.05);在复检时间点C、E组治愈率高于A、B、D组,D、E 2组6个月、12个月治愈率比较差异均有统计学意义(P值均＜0.05)。结论 BS MRI影像学分型具有特征性,有助于临床诊断及鉴别诊断,各型均有适合的治疗方法,以Ⅰ型非手术治疗,Ⅱ、Ⅳ型微创术,Ⅲ、Ⅴ型病灶清除植骨内固定术为佳。

The diagnosis and therapeutic value of MRI images typing for brucella spondylitis disease

Objective To explore the value of MRI classifications in diagnosis and treatment for Brucella spondylitis disease.Methods The clinical data of 257 patients with Brucella spondylitis that confirmed by clinical and laboratory examination from January 2002 to July 2013 were analyzed retrospectively. These cases included 131 males and 126 females. The age ranged from 21 to 82, and the average age was (46.52±1.27). These cases were classified according to the MRI imaging manifestations, such as disease location, extent of inflammatory infiltration and damage in vertebrae and intervertebral space, paraspinal soft tissue changes, stability of the spine, spinal cord or cauda equina nerve root compression,etc. Treatments included non-surgical and surgical treatment, non-surgical treatment was simple medication (A group), surgical treatment include limitations of minimally invasive lumbar lesions(B group), cervical debridement and internal fixation(C group), thoracic lumbar bone debridement surgery(D group), and thoracic lumbar bone debridement and internal fixation(E group). The relativity of clinical treatment strategies and imageology classification judged by the clinical efficacy were evaluated and researched. The data were analyzed with consistency check of image analysis.Results In the 257 cases of Brucellosis spondylitis, there were 47 cases of type Ⅰ, 45 cases of Ⅱ type, 41 cases of type Ⅲ, 32 cases of type Ⅳ, and 92 cases of type Ⅴ. All the 257 cases included 241 cases of damage involving 2 vertebral bodies and 16 cases of damage involving 3 vertebral bodies. The highest incidence was in lumbar(63.36%, 168/257). Three months after treatment, 257 cases were reviewed. Six months after treatment, the review number was 212 cases (82.49%) which included 134 cases of surgical treatment, 78 cases of non-surgical treatment, 5 recurrence cases of A group(1 case of lumbar Ⅱ type, 2 cases of type Ⅲ and 2 cases of Ⅳ type), and 2 recurrence cases of B group(1 case of lumbar Ⅱ type and a case of Ⅳ type). The total 7 recurrence cases were instead treatment of group E. Twelve months after treatment, the review number was 173 cases (67.31%) which included 112 cases of surgical treatment, 61 cases of non-surgical treatment, and no recurrence cases. Whether early or late postoperative, spine stability and bone graft fusion occurred in all cases of group C and E. Among the 50 cases treated with intertransverse facet bone grafting in the group D (total 56 cases)included 19 cases (38%) of spine stability and bone graft fusion and 31 cases (62%) of bone graft absorption (After treatment group E, 16 cases with spinal instability and low back pain were spine stability and bone graft fusion). Image analysis agreement κ values were more than 0.75. Clinical efficacy displayed when compared a point in time after and before in each group, the differences of cure rate were statistically significant(all P values＜0.05). At the same time points, cure rates in group C and E were more than those in group A, B and D. The differences of cure rate were statistically significant between group D and E in 6 months or 12 months (all P values＜0.05 ).Conclusions MRI imaging classification of Brucellosis spondylitis has some characteristics and contributes to clinical diagnosis and differential diagnosis. Each has the appropriate treatment strategy, for examples, typeⅠis suitable for non-surgical treatment, typeⅡ and Ⅳ for minimal invasive, and type Ⅲ and Ⅴ for debridement and internal fixation.