• 1河北北方學(xué)院附屬第一醫(yī)院骨科（河北張家口，075000）;;
  • 2河北醫(yī)科大學(xué)第四醫(yī)院神經(jīng)外科;;
  • 3 河北北方學(xué)院人體解剖與組織胚胎學(xué);

【摘 要】 目的  探討布魯桿菌病性脊椎炎有效的外科治療方法及臨床效果。 方法  2002年1月－2010年10月，對(duì)78例具有手術(shù)指征的胸腰椎布魯桿菌病性脊椎炎患者采用一期病灶清除聯(lián)合后路椎弓根內(nèi)固定治療。男42例，女36例；年齡24～65歲，平均45歲。病程8～29個(gè)月，平均12個(gè)月。2個(gè)椎體受累70例，3個(gè)椎體受累8例。均合并不同程度神經(jīng)功能損傷。術(shù)后隨訪行疼痛視覺模擬評(píng)分（VAS）、神經(jīng)功能Frankel分級(jí)、臨床療效評(píng)價(jià)以及X線片、MRI影像學(xué)觀察。 結(jié)果  術(shù)后78例均獲隨訪，隨訪時(shí)間12～30個(gè)月，平均26個(gè)月。無竇道形成及復(fù)發(fā)。術(shù)前及術(shù)后1、3、6、12個(gè)月VAS評(píng)分分別為（9.2 ± 0.6）、（2.4 ± 0.3）、（1.0 ± 0.2）、（0.5 ± 0.4）及0分，術(shù)后各時(shí)間點(diǎn)均較術(shù)前顯著改善（P  lt; 0.05）。術(shù)后各時(shí)間點(diǎn)神經(jīng)功能Frankel分級(jí)均較術(shù)前顯著改善，差異均有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05），其中C、D級(jí)改善最為顯著。臨床療效評(píng)價(jià)：術(shù)后12個(gè)月內(nèi)均無加重患者；隨時(shí)間推移，改善及無變化患者逐漸轉(zhuǎn)向痊愈，術(shù)后12個(gè)月改善率和痊愈率分別為100%和91.03%。影像學(xué)評(píng)價(jià)：術(shù)前及術(shù)后1、3、6、12個(gè)月影像學(xué)盲測評(píng)價(jià)指標(biāo)評(píng)分分別為（0.17 ± 0.03）、（4.11 ± 0.09）、（4.68 ± 0.04）、（4.92 ± 0.08）及5分，術(shù)后各時(shí)間點(diǎn)均較術(shù)前顯著改善（P  lt; 0.05）。 結(jié)論  一期病灶清除聯(lián)合后路椎弓根內(nèi)固定治療胸腰椎布魯桿菌病性脊椎炎，在解除疼痛、穩(wěn)定脊柱、恢復(fù)神經(jīng)功能及早期康復(fù)方面均有明顯優(yōu)勢。

引用本文： 楊新明 ,張磊,張瑛,王耀一,孟憲勇,陰彥林,石蔚,張軍威,張培楠,趙御森. 一期病灶清除聯(lián)合后路椎弓根內(nèi)固定治療胸腰椎布魯桿菌病性脊椎炎. 中國修復(fù)重建外科雜志, 2012, 26(3): 266-271. doi: 復(fù)制

1. 1 楊新明, 石蔚, 杜雅坤, 等. 布魯桿菌性脊柱炎臨床療效觀察. 中國地方病學(xué)雜志, 2008, 27(6): 699-703. 2 楊新明, 石蔚, 陰彥林, 等. 布氏桿菌性脊柱炎流行病學(xué)調(diào)查和臨床藥物治療的相關(guān)研究. 實(shí)用醫(yī)學(xué)雜志, 2008, 24(9): 1632-1634.
2. 楊新明, 石蔚, 杜雅坤, 等. 布魯桿菌病性脊柱炎的臨床影像學(xué)表現(xiàn)及外科治療. 中華骨科雜志, 2008, 28(1): 35-40.
3. 楊新明, 張磊, 劉肅, 等. 布魯桿菌病性脊柱炎//楊新明, 石蔚. 脊柱疾病. 北京: 科學(xué)技術(shù)文獻(xiàn)出版社, 2011: 271-275.
4. Saltoglu N, Tasova Y, Inal AS, et al. Efficacy of rifampicin plus doxycycline versus rifampicin plus quinolone in the treatment of brucellosis. Saudi Med J, 2002, 23(8): 921-924.
5. Turgut M, Turgut AT, Ko?ar U. Spinal brucellosis: Turkish experience based on 452 cases published during the last century. Acta Neurochir (Wien), 2006, 148(10): 1033-1044.
6. Ioannou S, Karadima D, Pneumaticos S, et al. Efficacy of prolonged antimicrobial chemotherapy for brucellar spondylodiscitis. Clin Microbiol Infect, 2011, 17(5): 756-762.
7. Raptopoulou A, Karantanas AH, Poumboulidis K, et al. Brucellar spondylodiscitis: noncontiguous multifocal involvement of the cervical, thoracic, and lumbar spine. Clin Imaging, 2006, 30(3): 214-217.
8. Namiduru M, Karaoglan I, Gursoy S, et al. Brucellosis of the spine: evaluation of the clinical, laboratory, and radiological findings of 14 patients. Rheumatol Int, 2004, 24(3): 125-129.
9. German V, Papadopoulos N, Diakalis C, et al. Paravertebral abscess and neurological deficits in cervical brucellar spondylitis. East Mediterr Health J, 2010, 16(4): 448-450.
10. Lee C, Dorcil J, Radomisli TE. Nonunion of the spine: a review. Clin Orthop Relat Res, 2004, (419): 71-75.
11. Pina MA, Modrego PJ, Uroz JJ, et al. Brucellar spinal epidural abscess of cervical location: report of four cases. Eur Neurol, 2001, 45(4): 249-253.
12. Ledermann HP, Schweitzer ME, Morrison WB, et al. MR imaging findings in spinal infections: rules or myths? Radiology, 2003, 228(2): 506-514.
13. Yilmaz MH, Mete B, Kantarci F, et al. Tuberculous, brucellar and pyogenic spondylitis: comparison of magnetic resonance imaging findings and assessment of its value. South Med J, 2007, 100(6): 613-614.
14. Tali ET. Spinal infenctions. Eur J Radiol, 2004, 50(2): 120-133.
15. Solis Garcia del Pozo J, Vives Soto M, Solera J. Vertebral osteomyelitis: long-term disability assessment and prognostic factors. J Infect, 2007, 54(2): 129-134.
16. Katonis P, Tzermiadianos M, Gikas A, et al. Surgical treatment of spinal brucellosis. Clin Orthop Relat Res, 2006, (444): 66-72.
17. Ates O, Cayli SR, Koççak A, et al. Spinal epidural abscess caused by brucellosis. Neurol Med Chir (Tokyo), 2005, 45(1): 66-70.
18. 王自立. 對(duì)徹底治愈脊柱結(jié)核病灶及其相關(guān)問題的管見. 中國脊柱脊髓雜志, 2008, 18(8): 568-570.
19. Ozdemir HM, Us AK, O?ün T. The role of anterior spinal instrumentation and allograft fibula for the treatment of pott diease. Spine (Phila Pa 1976), 2003, 28(5): 474-479.
20. Dai LY, Jiang LS, Wang W, et al. Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine (Phila Pa 1976), 2005, 30(20): 2342-2349.
21. Fukuta S, Miyamoto K, Masuda T, et al. Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine (Phila Pa 1976), 2003, 28(15): E302-308.
22. Bouaziz MC, Bougamra I, Kaffel D, et al. Noncontiguous multifocal spondylitis: an exceptional presentation of spinal brucellosis. Tunis Med, 2010, 88(4): 280-284.
  1. 1. 1 楊新明, 石蔚, 杜雅坤, 等. 布魯桿菌性脊柱炎臨床療效觀察. 中國地方病學(xué)雜志, 2008, 27(6): 699-703. 2 楊新明, 石蔚, 陰彥林, 等. 布氏桿菌性脊柱炎流行病學(xué)調(diào)查和臨床藥物治療的相關(guān)研究. 實(shí)用醫(yī)學(xué)雜志, 2008, 24(9): 1632-1634.
  2. 2. 楊新明, 石蔚, 杜雅坤, 等. 布魯桿菌病性脊柱炎的臨床影像學(xué)表現(xiàn)及外科治療. 中華骨科雜志, 2008, 28(1): 35-40.
  3. 3. 楊新明, 張磊, 劉肅, 等. 布魯桿菌病性脊柱炎//楊新明, 石蔚. 脊柱疾病. 北京: 科學(xué)技術(shù)文獻(xiàn)出版社, 2011: 271-275.
  4. 4. Saltoglu N, Tasova Y, Inal AS, et al. Efficacy of rifampicin plus doxycycline versus rifampicin plus quinolone in the treatment of brucellosis. Saudi Med J, 2002, 23(8): 921-924.
  5. 5. Turgut M, Turgut AT, Ko?ar U. Spinal brucellosis: Turkish experience based on 452 cases published during the last century. Acta Neurochir (Wien), 2006, 148(10): 1033-1044.
  6. 6. Ioannou S, Karadima D, Pneumaticos S, et al. Efficacy of prolonged antimicrobial chemotherapy for brucellar spondylodiscitis. Clin Microbiol Infect, 2011, 17(5): 756-762.
  7. 7. Raptopoulou A, Karantanas AH, Poumboulidis K, et al. Brucellar spondylodiscitis: noncontiguous multifocal involvement of the cervical, thoracic, and lumbar spine. Clin Imaging, 2006, 30(3): 214-217.
  8. 8. Namiduru M, Karaoglan I, Gursoy S, et al. Brucellosis of the spine: evaluation of the clinical, laboratory, and radiological findings of 14 patients. Rheumatol Int, 2004, 24(3): 125-129.
  9. 9. German V, Papadopoulos N, Diakalis C, et al. Paravertebral abscess and neurological deficits in cervical brucellar spondylitis. East Mediterr Health J, 2010, 16(4): 448-450.
  10. 10. Lee C, Dorcil J, Radomisli TE. Nonunion of the spine: a review. Clin Orthop Relat Res, 2004, (419): 71-75.
  11. 11. Pina MA, Modrego PJ, Uroz JJ, et al. Brucellar spinal epidural abscess of cervical location: report of four cases. Eur Neurol, 2001, 45(4): 249-253.
  12. 12. Ledermann HP, Schweitzer ME, Morrison WB, et al. MR imaging findings in spinal infections: rules or myths? Radiology, 2003, 228(2): 506-514.
  13. 13. Yilmaz MH, Mete B, Kantarci F, et al. Tuberculous, brucellar and pyogenic spondylitis: comparison of magnetic resonance imaging findings and assessment of its value. South Med J, 2007, 100(6): 613-614.
  14. 14. Tali ET. Spinal infenctions. Eur J Radiol, 2004, 50(2): 120-133.
  15. 15. Solis Garcia del Pozo J, Vives Soto M, Solera J. Vertebral osteomyelitis: long-term disability assessment and prognostic factors. J Infect, 2007, 54(2): 129-134.
  16. 16. Katonis P, Tzermiadianos M, Gikas A, et al. Surgical treatment of spinal brucellosis. Clin Orthop Relat Res, 2006, (444): 66-72.
  17. 17. Ates O, Cayli SR, Koççak A, et al. Spinal epidural abscess caused by brucellosis. Neurol Med Chir (Tokyo), 2005, 45(1): 66-70.
  18. 18. 王自立. 對(duì)徹底治愈脊柱結(jié)核病灶及其相關(guān)問題的管見. 中國脊柱脊髓雜志, 2008, 18(8): 568-570.
  19. 19. Ozdemir HM, Us AK, O?ün T. The role of anterior spinal instrumentation and allograft fibula for the treatment of pott diease. Spine (Phila Pa 1976), 2003, 28(5): 474-479.
  20. 20. Dai LY, Jiang LS, Wang W, et al. Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine (Phila Pa 1976), 2005, 30(20): 2342-2349.
  21. 21. Fukuta S, Miyamoto K, Masuda T, et al. Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine (Phila Pa 1976), 2003, 28(15): E302-308.
  22. 22. Bouaziz MC, Bougamra I, Kaffel D, et al. Noncontiguous multifocal spondylitis: an exceptional presentation of spinal brucellosis. Tunis Med, 2010, 88(4): 280-284.