脊柱布氏杆菌病的诊断与治疗

发布时间：2019-01-12 07:55

【摘要】：背景:近几年,脊柱布氏杆菌病呈明显上升趋势,而脊柱布氏杆菌病缺乏特异性的诊断指标,鉴别诊断较困难。目的:回顾性分析我院收治的16例脊柱布氏杆菌病患者特点,观察脊柱布氏杆菌病的诊断规律、治疗要点、预后情况。方法:收集1999年1月至2015年9月我院收治的16例脊柱布氏杆菌病患者的病例资料。总结分析患者的病史、临床表现以及血清学、细菌学、影像学改变以及临床治疗与预后。结果:男女各8例,平均年龄49.25岁,主诉以剧烈腰背痛或臀部疼痛为主,均有牛羊接触史。平均病史3个月。实验室检查:14例(87.5%)红细胞沉降率增快,15例(93.75%)单核细胞或单核细胞百分率升高,所有16例患者的CRP升高、白细胞计数正常(100%)。血培养全部为阴性,活检组织细菌培养阳性率50%。病变主要累及腰椎(13例,81.25%)。影像学检查:7例(63.6%)X线片及CT出现"鹦鹉嘴样"改变,10例(71.4%)MRI表现T2等信号、T1低信号、压脂像高信号。9例患者手术治疗,保守治疗7例,随访2.5~197.0个月,平均20.22个月。所有患者预后良好。结论:有以下特征时应高度怀疑脊柱布氏杆菌病:剧烈腰背痛,单核细胞升高,有牛羊接触史,X线椎体前缘"鹦鹉嘴样"改变、MRI上T2等信号、T1低信号、压脂像高信号,血清学检查明确确诊。除严重脊髓或神经压迫者,保守治疗可达到较好的预后效果。
[Abstract]:Background: in recent years, brucellosis of the spine shows an obvious upward trend, but the spinal brucellosis lacks the specific diagnostic index, so it is difficult to differentiate the diagnosis. Objective: to analyze retrospectively the characteristics of 16 cases of spinal brucellosis in our hospital, and to observe the diagnosis, treatment and prognosis of spinal brucellosis. Methods: 16 cases of spinal brucellosis were collected from January 1999 to September 2015. The history, clinical manifestations, serological, bacteriological, imaging changes, clinical treatment and prognosis of the patients were summarized and analyzed. Results: there were 8 cases of male and female with an average age of 49.25 years. The main complaint was severe low back pain or hip pain, all of them had a history of contact with cattle and sheep. The mean history was 3 months. Laboratory examination showed that erythrocyte sedimentation rate increased rapidly in 14 cases (87.5%), monocyte or monocyte percentage increased in 15 cases (93.75%), CRP increased in all 16 cases and white blood cell count was normal (100%). All the blood cultures were negative, and the positive rate of bacterial culture in biopsy tissues was 50%. Lumbar vertebrae were mainly involved (13 cases, 81.25%). Imaging examination showed that 7 cases (63.6%) had "parrot beak-like" changes in X-ray film and CT, 10 cases (71.4%) showed T2 signal intensity, T _ 1 low signal intensity and hyperintense signal intensity in T _ 1.Nine cases were treated surgically and 7 cases were treated conservatively. The follow-up ranged from 2.5 to 197 months, with an average of 20.22 months. All patients had a good prognosis. Conclusion: spinal brucellosis should be highly suspected when it has the following characteristics: severe low back pain, elevated monocytes, history of contact with cattle and sheep, changes of "parrot beak" in the front edge of X-ray vertebra, T2 signal on MRI, low signal intensity on T1, high signal intensity in pressure image. Serological examination confirmed the diagnosis. In addition to severe spinal cord or nerve compression, conservative treatment can achieve better prognosis.
【作者单位】：青岛大学医学院附属医院骨科;
【分类号】：R516.7

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