Manifestation of clinical imageology and surgical treatment of the brucellosis spondylitis / 中国矫形外科杂志

ABSTRACT

[Objective] To improve the clinical diagnosis and therapic effect and to discuss the clinical and imageologic manifestations and treatment of the brucellosis spondylitis(BS).[Method]Sixteen 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 anti-brucellosis agents and other conservative measures.Seven cases were followed with a focal debridement and 2 cases withminimal invasive surgery.[Result]Fourteen 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 morbidity 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 1～2 years(including 8 surgical-treated cases).Ten cases were cured without recurrence,and 2 cases improved.[Conclusion]Brucellosis spondylitis commonly misdiagnose before hospitalization.Characteristic imageologic changes and clinical appearance,combined tests of SAT and RBP are useful for diagnosis.Long-term and enough amount sensitive antibiotics and other conservative measures is still the major and reliable measures in treatment of BS and prevent recurrence,additional minimal invasive surgery or focal debridement could shorten the course of therapy,increase the cure rate and decrease its complication.