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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:

期数:

2020年01期

页码:

39-47

栏目:

脊柱疾患

出版日期:

2020-02-05

文章信息/Info

Title:

Establishment of clinical diagnosis system and evaluation of curative effect of brucellosis spondylitis in the elderly

作者:

杨新明; 张瑛; 石蔚; 姚尧; 田野

075000 张家口，河北北方学院附属第一医院骨科

Author(s):

Yang Xinming;  Zhang Ying;  Shi Wei;  Yao Yao;  Tian Ye

Department of Orthopedics, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China

关键词:

布鲁杆菌病;  脊椎炎;  规范化;  诊断;  临床治疗

Keywords:

Brucelliasis;  Spondylitis;  Standardization;  Diagnosis;  Clinical treatment

DOI:

10.3877/cma.j.issn.2096-0263.2020.01.008

文献标志码:

A

摘要:

目的 建立老年布鲁杆菌病性脊椎炎（BS）临床诊断体系，评价治疗方法，以便提高该病诊断率和治愈率。方法 回顾性分析2002年1月至2017年12月河北北方学院附属第一医院收治的70例老年BS患者，按照诊断体系对患者进行病史、临床、影像、实验室和病理学检查，且依据诊断标准确定为确诊病例。所有患者均伴有不同程度心脑血管病、低蛋白血症、中重度营养不良、骨质疏松症和深静脉血栓。依据是否手术分为两组：药物治疗组28例，药物+手术治疗组42例。两组患者依据VAS评分、影像学评分、临床效果指标对治疗方法进行评价。治疗后3个月、6个月、12个月作为主要随访与评价点。结果 70例患者均获得随访，随访时间为6～12个月，平均为（11.82±0.24）个月。末次随访时两组患者治疗前合并症均得到有效控制，药物+手术治疗组患者无复发、断钉、断棒及窦道形成，椎间隙植骨愈合良好，脊柱稳定性佳。两组治疗方法均可使VAS评分降低（P＜0.05），药物+手术治疗组治疗后3个月、6个月、12个月VAS评分均为0分。两组影像学评分逐渐升高（P＜0.05），药物+手术治疗组治疗后6个月、12个月达到10分。两组临床治愈率逐渐升高（P＜0.05），药物+手术治疗组治疗后6个月、12个月达到100%。结论 符合非手术适应证的老年BS患者，围手术期应用多学科协作、规范化药物治疗即可获得良好的临床疗效；符合手术适应证患者，实施手术干预临床治愈率可达到100%，疗效佳。

Abstract:

Objective To establish the clinical diagnosis system of brucellosis spondylitis (BS) in the elderly and evaluate the treatment methods, so as to improve the diagnosis rate and cure rate of the disease. Methods Retrospective analysis of 70 elderly BS patients admitted to the first affiliated hospital of hebei northern university from January 2002 to December 2017. History, clinical, imaging, laboratory and pathology examinations were performed in accordance with the diagnostic system and it was confirmed as a confirmed case according to the diagnostic criteria. All patients were associated with varying degrees of cardiovascular and cerebrovascular disease, hypoproteinemia, moderate to severe malnutrition, osteoporosis and deep vein thrombosis. According to whether the operation was performed, the patients were divided into two groups: drug treatment group with 28 cases and drug+surgical treatment group with 42 cases. The two groups of patients evaluated the treatment methods according to VAS score, imaging score and clinical effect index. 3 months, 6 months and 12 months after treatment were selected as the main follow-up and evaluation points. Results All 70 patients were followed up for 6 to 12 months, with an average of 11.82±0.24 months. At the end of the follow-up, the complications of the two groups before treatment were effectively controlled. In drug+surgical treatment group, there was no recurrence, broken screw, broken rod or formation of sinus tract, intervertebral bone graft healing was good, and spinal stability was good. VAS scores were reduced in both groups.VAS scores in drug+surgical treatment group were 0 points at 3 months, 6 months and 12 months after treatment. The imaging scores of the two groups increased gradually, reaching 10 points at 6 months and 12 months after treatment in the drug + surgical treatment group. The clinical cure rate of the two groups increased gradually (P<0.05), and that of the drug+surgical treatment group reached 100% at 6 and 12 months after treatment. Conclusions For BS patients with non-surgical indications, the application of multidisciplinary collaboration and standardized drug therapy in the perioperative period can achieve good clinical efficacy. In line with surgical indications, the curative rate of surgical intervention can reach 100% and the curative effect is good.

备注/Memo

备注/Memo:

2018年度河北省卫生健康技术研究暨成果转化重点项目（zh2018014）；2018年度河北省医学适用技术跟踪项目（G2018074）；2017年张家口市市级科技计划（17120010D）；2018年度河北北方学院校级科研项目（YB2018010）；2020年度河北省卫健委医学科学研究课题计划（20200504）

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更新日期/Last Update: 2020-07-07