Abstract：ObjectiveTo explore the standardized diagnostic procedure of Brucellosis spondylitis (BS). MethodsFrom January 2008 to March 2021, 116 patients with BS were admitted to the Department of Orthopaedics of the First Affiliated Hospital of Hebei North University for retrospective analysis of their clinical manifestations, epidemiological history, imaging, laboratory, etiological, and pathological findings, and the diagnostic characteristics of BS were summarized. Patients were classified into nonsurgical treatment group (n=42) and surgical treatment group (n=74) based on whether or not surgery was performed, and clinical efficacy was assessed at 3, 6, and 12 months after treatment. ResultsThe 116 individuals all had brucellosis epidemiological histories, with clinical signs of relaxing fever, lumbago, and poor daily living abilities. The X-ray of spine revealed early bone degradation and intervertebral space stenosis, as well as a robust "bird′s beak" reaction to late bone healing. CT showed uniform disc density destruction, "labial" osteophytes, "lacework", and paravertebral abscesses. MRI showed the disappearance of the "central fracture sign" of the disc, spinal cord or dural sac compression, paraspinal abscess, and vertebral Schmorl nodular bone destruction.
The rose bengal plate agglutination test (RBPT) had a positive rate of 37.07% (43/116), the standard tube agglutination test (SAT) had a positive rate of 69.86% (51/73), and the anti-human globulin test (Coomb′s test) had a 100.00% (22/22) positive rate. Brucella culture showed a colorless and transparent S-type colony. Under the microscope, it showed Gramnegative small bacilli and purple Jim stain. The positive rate of blood culture was 17.24% (20/116), bone marrow culture was 37.50%(36/96), and inflammatory tissue or pus culture was 51.35%(38/74). The pathological characteristics of 74 patients were nontuberculous inflammatory granuloma in the central area and proliferative nodules in the peripheral area. There were no complications, recurrence or damage of liver or kidney function in 2 groups at 3, 6 and 12 months after treatment, and the cure rate increased gradually with the passage of time.
ConclusionsThe epidemiological history, clinical imaging manifestations, laboratory tests, etiology and pathological examinations of BS showed characteristic features. The establishment of standardized diagnostic system and diagnostic criteria are helpful to improve the diagnosis rate and differential diagnosis, and correct diagnosis is the premise of the correct implementation of individualized treatment.
杨新明 杨超伟 姚尧 田野 陈丽星 张瑛. 布鲁氏菌性脊柱炎规范化诊断的临床研究[J]. 中华诊断学电子杂志, 2022, 10(4): 217-223.
Yang Xinming, Yang Chaowei, Yao Yao, Tian Ye, Chen Lixing, Zhang Ying. Clinical study on standardized diagnosis of Brucellosis spondylitis. zhzdx, 2022, 10(4): 217-223.
