布氏杆菌性脊柱炎临床影像学表现及外科治疗【临床医学论文】
11页1、临床医学论文-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 1160,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,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 12 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
2、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Abstract:ObjectiveTo improve the clinical diagnosis and therapic effect and to discuss the clinical and imageologic manifestations and treatment of the brucellosis spondylitis(BS).MethodSixteen patients with BS were all taken radiographs and CT scanning and seven cases were also taken MRI.The test of SAT,test of RBP and ELISA were used in accessing BS.Pathogenic bacteria were examined in 11 cases.All cases were treated with antibrucellosis
3、agents and other conservative measures.Seven cases were followed with a focal debridement and 2 cases withminimal invasive surgery.ResultFourteen cases were misdiagnosed as spine TB before they were hospitalized with rate of error diagnosis 87.5%,even careful clinic and radiographic examination,and CT scanning had been taken,and 5 cases were misdiagnosed by MRI with the misdiagnosis rate 71.4%.The BS occurred far more in the lumbar vertebrae than in the thoracic vertebrae with its highest morbid
4、ity at the L4.Among 16 cases,the titers of SAT test were all beyond 1.160,the test of RBP all showed positive and IgG,IgM showed positive by ELISA.Eleven cases was confirmed BS diagnosis by phthogenic bacteria examination.Only 12 cases were followed up for 12 years(including 8 surgicaltreated cases).Ten cases were cured without recurrence,and 2 cases improved.ConclusionBrucellosis spondylitis commonly misdiagnose before hospitalization.Characteristic imageologic changes and clinical appearance,c
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