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目的 探讨脊柱布氏杆菌病的临床特点、治疗策略及预后.方法 回顾性分析2009年9月至2016年6月,西京医院骨科收治的脊柱布氏杆菌感染经临床确诊、具有完整病历及随访资料的患者共21例,其中男17例,女4例;年龄11~67岁,平均(46.9±12.5)岁;病程14~240天,平均(80.7±64.1)天.对该组患者的发病特点、临床表现以及血清学、病原学、影像学的特征进行归纳分析,并观察采取不同治疗方案的临床预后.结果 本组21例均有局部疼痛症状,18例有羊接触史,16例有发热病史,10例有多汗病史,8例有乏力病史,5例有肌肉疼痛病史,4例有睾丸疼痛(附睾炎)病史.实验室检查结果:所有患者的布氏杆菌冷凝集试验均为阳性,结核T-Spot试验均为阴性;4例布氏杆菌血培养呈阳性.入院血沉22.8~93 mm/h,平均(57.2±20.5)mm/h;超敏C反应蛋白6.12~152 mg/L,平均(45.5±31.7)mg/L.本组病例中,颈椎2例,胸椎1例,腰骶段3例,腰椎15例,11例存在椎管内和(或)椎旁脓肿形成,但仅有1例患者存在明显神经功能障碍(肌力<3级).所有患者X线片及CT均出现受累椎间隙狭窄或稍变窄,椎体骨质不同程度破坏.MRI显示病变椎体在T1像上表现为不均匀中等偏低信号,在T2像上呈现不同程度高信号.7例(2例颈椎,5例腰椎)接受病灶清理+植骨融合内固定手术,14例接受保守治疗.所有患者均采用WHO推荐的治疗方案:其中3例采用三联抗炎,18例采用两联抗炎.15例采用盐酸多西环素+利福平联合治疗,3例采用盐酸多西环素+利福平+左氧氟沙星联合治疗,2例采用链霉素+利福平联合治疗,1例采用米诺环素+利福平联合治疗,抗炎药物使用时间6~10周,平均(7.5±1.6)周.术后随访2~80个月,平均(25.7±18.5)个月,患者感染局部及全身症状明显消失,椎管内脓肿吸收,神经功能恢复良好,无感染复发病例.结论 脊柱布氏杆菌病最常累及腰骶椎,局部疼痛、发热及牛羊接触的病史是较为典型的临床特征.患者血沉和超敏C反应蛋白显著升高,但布氏杆菌血培养阳性率较低.冷凝集试验是确诊本病的重要手段.手术指征应当严格控制,对于椎管内脓肿较多出现严重神经功能障碍患者,可考虑行手术治疗,多数患者保守治疗有效.“,”Objective To analyze clinical data of patients with spinal brucellosis and to summarize clinical characteristics, treatment strategy and prognosis of the disease. Methods From September 2009 to June 2016, 21 patients with spinal brucellosis were treated in our hospital. The diagnosis was clinically confirmed, and all of them had complete medical records and follow-up data. There were 17 males and 4 females, with a mean age of ( 46.9 ± 12.5 ) years ( range: 11 - 67 years ). The average course was ( 80.7 ± 64.1 ) days ( range: 14 - 240 days ). Their clinical data were collected and analyzed retrospectively, including the complaints, clinical manifestations, serological and etiological results and imaging changes. The clinical outcomes of different treatment options were observed. Results They complained mainly about local pain ( n = 21 ), history of exposure to cattle or sheep ( n = 18 ), fever ( n = 16 ), sweats ( n = 10 ), fatigue ( n = 8 ), myalgia ( n = 5 ) and testicular pain ( epididymitis ) ( n = 4 ). As to the laboratory examination, positive results were obtained in the standard tube agglutination test, and negative results in the T-spot TB test in all the patients. Cultures of blood specimens from 4 patients were positive for brucella melitensis. The mean value of erythrocyte sedimentation rate ( ESR ) was ( 57.2 ± 20.5 ) mm / h ( range: 22.8 - 93 mm / h ). The mean value of hypersensitive C-reactive protein ( CRP ) was ( 45.5 ± 31.7 ) mg / L ( range: 6.12 - 152 mg / L ). The defect site was noted in cervical spine of 2 cases, thoracic spine of 1 case, lumbosacral spine of 3 cases and lumbar spine of 15 cases. Paravertebral masses and / or epidural masses were detected in 11 patients, but only 1 patient had significant neurological dysfunction ( myodynamia < grade 3 ). The X-ray and CT showed infected intervertebral disc stenosis or slightly narrow and affected vertebral body bone destruction in 21 cases. The MRI showed uneven hypointense on T1-weighted images and uneven hyperintense on T2-weighted sequences of the intervertebral disc in 21 cases. Seven patients ( 2 cases of cervical spinal brucellosis and 5 cases of lumbar spinal brucellosis ) underwent the surgery of focal cleaning, bone graft fusion and internal fixation, and 14 patients were treated by oral medicine. World Health Organization ( WHO ) recommended treatment was performed on all the patients, with a combination of 2 ( in 18 cases ) or 3 ( in 3 cases ) agents. Fifteen patients received a combination of tetracycline and rifampicin. Three patients received a combination of doxycycline, rifampicin, and levofloxacin. Two patients received a combination of streptomycin and rifampicin. One patient received a combination of minocycline and rifampicin. The mean duration of antimicrobial treatment was ( 7.5 ± 1.6 ) weeks ( range: 6 - 10 weeks ). The mean duration of follow-up was ( 25.7 ± 18.5 ) months ( range: 2 - 80 months ). Good prognosis was achieved in all the patients, without any local infections or systemic symptoms. Resolution of epidural or paravertebral masses and recovery of neurological function occurred in all the patients. There were no clinical or radiological relapses. Conclusions The lumbar spine is the most frequent level involved in spinal brucellosis. Most patients have typical clinical features of local pain, fever and exposure to cattle or sheep. The ESR and CRP values increase significantly, while the positive rate of brucella blood culture is lower. So the standard tube agglutination test is an important means in the diagnosis of this disease. The conservative treatment can be effective for most patients. Surgical indications should be strictly controlled. If a localized infection focus or extradural abscess compresses the spinal cord and / or the nerve root, causing severe neurological dysfunction, the surgical discectomy procedure should be used.