腰椎布氏菌性脊柱炎影像与病理观察

发布时间：2018-11-16 10:21

【摘要】：[目的]探讨腰椎布氏菌性脊椎炎病变椎间盘不同时期病理特点。[方法]2012年11月~2015年3月,88例行手术治疗的腰椎布氏菌性脊柱炎患者,男72例,女16例,年龄40~68岁,平均52.6岁。76例行腰椎后路病灶清除、减压、内固定、植骨融合术,12例行椎间孔镜下病灶清除术。术前收集X线片、CT及MRI等影像资料,术中收集病变椎间盘,采用HE和Gimesa染色进行病理观察。[结果]X线片及CT显示88例患者椎间盘均可见炎性改变,其中椎间盘破坏者84例,12例表现为早期椎间隙正常或轻度变窄,多为1~2个临近椎体终板及终板下局灶性骨质毁坏;76例表现为中晚期椎间隙明显变窄,可累及大部分甚至整个椎体,表现为空洞、破坏、硬化、增生。MRI显示12例早期病变椎间盘T1WI呈稍低信号或等信号,T2WI及压脂T2WI呈不均匀混杂高信号,增强后不均匀强化;76例中晚期病变椎间盘T1WI呈低信号,T2WI及压脂T2WI呈高信号,增强后明显强化。病理结果示88例病变椎间盘均可见布鲁氏菌Gimesa染色阳性;HE染色发现早期病变椎间盘大量炎症细胞增殖,包含大量单核细胞、淋巴细胞、中性粒细胞、嗜酸性细胞,中晚期病变椎间盘纤维组织广泛增生。[结论]腰椎布氏菌性脊椎炎病变椎间盘不同时期病理表现具有特征性,对临床诊断和治疗方案的选择可提供重要的参考信息。
[Abstract]:[objective] to investigate the pathological characteristics of lumbar disc with brucellosis spondylitis. [methods] from November 2012 to March 2015, 88 patients (72 males and 16 females) with lumbar spondylitis treated surgically, aged 40 to 68 years (mean 52.6 years), underwent posterior lumbar debridement, decompression and internal fixation. Bone grafting and fusion were performed in 12 cases. X-ray films, CT and MRI were collected before operation, and disc lesions were collected during operation. HE and Gimesa staining were used for pathological observation. [results] Eighty-eight patients showed inflammatory changes in intervertebral disc by X-ray and CT, including 84 cases of disc destruction, 12 cases showed normal or slight narrowing of intervertebral space at early stage, most of them were 1 ~ 2 adjacent vertebral endplate and focal destruction of bone under endplate. 76 cases showed obvious narrowing of intervertebral space in middle and late stage, which could involve most or even the whole vertebral body, and showed cavitation, destruction, sclerosis and hyperplasia. MRI showed that T1WI of early lesion of intervertebral disc showed slightly low signal intensity or isointense signal in 12 cases. T2WI and T2WI were heterogeneous and mixed with high signal intensity, and enhanced inhomogeneously after enhancement. In 76 cases of middle and late stage disc, T1WI showed low signal intensity, T2WI and fat pressing T2WI showed high signal intensity, and enhanced obviously after enhancement. The pathological results showed that brucella Gimesa staining was positive in 88 cases. HE staining showed that a large number of inflammatory cells proliferated in the early stage of the disc, including a large number of monocytes, lymphocytes, neutrophils, eosinophils, and extensive proliferation of fibrous tissue of the intervertebral disc in the middle and late stage. [conclusion] the pathological manifestations of lumbar vertebrae with brucellosis are characteristic in different stages, which can provide important reference information for clinical diagnosis and treatment.
【作者单位】：首都医科大学附属北京地坛医院骨科/感染病科国家临床重点专科建设项目;首都医科大学附属北京地坛医院病理科;
【分类号】：R681.5

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