JoVE Journal > Medicine
Summary
Abstract
Introduction
Protocol
Ergebnisse
Discussion
Offenlegungen
Acknowledgements
Materials
Referenzen
Automatische Übersetzung
Please note that all translations are automatically generated. Click here for the English version.
Medizin

人类布鲁塞拉性皮诺皮诺皮炎的诊断和手术治疗

Published: May 23, 2021
doi:
10.3791/61840
, , , , , ,
1Department of Spine Surgery,First Affiliated Hospital of Xinjiang Medical University, 2Center of Experimental Orthopaedics,Saarland University Medical Center, 3Sino Euro Orthopaedics Network (SEON)

Summary

我们描述了一种临床算法，基于数十年来在中国新疆牧区最大的医疗中心诊断和手术治疗人类布鲁氏菌性皮炎的前线经验。

Abstract

布鲁沙尔海绵状腺炎（BS）是人类布鲁氏菌病最普遍和最重要的骨关节表现，在牧区社区中普遍表现。很难进行差异诊断，通常会导致不可逆转的神经缺陷和脊柱畸形。BS的初步诊断基于临床发现和放射学评估，确认的诊断应通过 将布鲁塞拉 物种与血液和/或标准管凝结试验隔离来确定。多焦BS与退行性椎间盘疾病或结核病的差异诊断尤为突出。手术方法，无论是内窥镜还是开放，都经过详细演示，并附有结构压缩或严重不稳定的放射学证据。此外，还解释了关键的手术步骤，包括单阶段转前减压、脱轨、体间融合和内部固定。此外，还涉及术外护理和术后康复。综合起来，该临床算法提供了一个实用指南，在过去几十年中取得了非常令人满意的结果，也可以引入大规模应用来管理人类BS，特别是在流行地区。

Introduction

每年有超过50万新发病例，人类布鲁氏菌病已成为公共卫生问题，仍然是全世界1，2，3，4的巨大负担。BS，作为人类布鲁氏菌病最常见和最严重的骨关节表现，涉及多种结构，包括椎体、椎间盘和副脊椎结构5，6。它经常发生在隆博囊区，需要区别于其他传染病，因为它的非特异性临床特征7，8。尽管在过去几十年中研究取得了重大进展，但由于其晚发放射学发现、血液培养增长缓慢以及血清诊断9的复杂性，准确和及时的BS诊断对临床医生来说仍然是一个挑战。因此，人类BS在临床上仍然被诊断不足和报告不足。虽然过去数十年来，在引入和推广若干治疗指南方面进展迅速，但仍未就最佳管理模式10达成共识。频繁复发，治疗失败，和后遗症不断报告11。

值得注意的是，BS 可能严重衰弱和致残，即使它很少致命。如果不适当治疗，可能会诱发严重的后遗症，包括持续背痛，神经缺乏，甚至kyphotic畸形12，13。抗生素治疗是BS治疗的核心，并产生普遍有希望的结果9。然而，如果观察到神经功能障碍、脊柱不稳定、脓肿形成、难以解决的疼痛或以前对保守治疗的不尽如人意的反应，某些患者可能需要手术治疗。手术干预仍然引起争议。对腰椎传染病，包括前部、后部和组合方法14、15、16等，进行了不同的脱毛和融合手术。在这里，已经提出了诊断指南，为人类BS和单阶段手术治疗与跨前解压缩，脱轨，体间融合，和内部固定通过后只的方法。下面提供了此方法的详细协议。

Protocol

这项研究得到了新疆医科大学第一附属医院伦理委员会的批准。 1. 知情同意 在解释手术、术后预后和可能的并发症（感染、硬膜外血肿、脊髓损伤、内固定失败和脑脊液泄漏）的细节后，获得患者的知情同意。 解释通常与使用植入物（如内部固定系统）相关的其他风险，如对植入材料的过敏或免疫系统反应。 排除对患者的任何禁忌?…

Representative Results

本文描述了一项前瞻性、非随机性、对照性研究，这些患者在中国乌鲁木齐市新疆医科大学第一附属医院脊柱外科的单阶段转口减压、脱脂、体间融合和内固定治疗。 图1 显示了本研究中的一个典型案例。 临床症状总结在 表2。患者通常抱怨慢性背痛，有神经损伤的迹象。布鲁塞拉凝血水平?…

Discussion

目前人类BS的诊断和手术治疗指南，具有详细的协议和来自代表性群体的令人满意的临床证据，显示了临床疗效，并建议大规模应用来管理人类BS，特别是在地方性地区。BS 治疗的第一个关键步骤是做出正确的诊断。BS的诊断需要区别于脊髓结核病相比，BS是相对较少的骨破坏性，通常有效地回应抗生素治疗38。此外，在BS患者的后期阶段，可以观察到明显的神经缺陷、持续疼痛、?…

Offenlegungen

The authors have nothing to disclose.

Acknowledgements

蔡晓宇博士感谢中国奖学金委员会的资助。本作品由中国新疆省自然科学基金委员会资助（第2016B03047-3号）。

Materials

Absorbable gelatin sponge Chuhe Medical Devices Co., Ltd. AWZ-035-XSMJHM-AD. 60 mm x 20 mm x 5 mm
Box curette  Rudischhauser GmbH R16-BD2310-ST Width: 7.5 mm; height: 5.9 mm; shaft: 6.0 mm (diameter); working length: 223 mm
Bone graft funnel  Rudischhauser GmbH R19-K00000-FU Working length: 246.5 mm; End diameter: 42 mm; shaft: 6.4 mm (diameter)
Bone pusher  Rudischhauser GmbH R19-EK4110-00 Working length: 220 mm; shaft: 6.0 mm (diameter)
Bone rongeur Vet Direct & VETisco EC-RG-BO-180 Length: 180 mm
Iodophor (1%) Beijing SanYao Science & Technology Development Co. 14975I Volume: 500 mL
Nerve retractor Rudischhauser GmbH R16-HD1710-00 Width: 10 mm; length: 145 mm; shaft: 5.0 mm (diameter)
Osteotome 1 Rudischhauser GmbH R16-CD2310-08 Width: 8 mm; height: 3 mm; shaft: 6.0 mm (diameter); working length: 223 mm
Osteotome 2 Rudischhauser GmbH R16-CD2310-10 Width: 10 mm; height: 3 mm; shaft: 6.0 mm (diameter); working length: 223 mm
Pedicle screw DePuy Synthes Companies 199723540 Length: 40 mm; diameter: 5.0 mm
DePuy Synthes Companies 199723545 Length: 45 mm; diameter: 5.0 mm
DePuy Synthes Companies 199723550 Length: 50 mm; diameter: 5.0 mm
DePuy Synthes Companies 199723640 Length: 40 mm; diameter: 6.0 mm
DePuy Synthes Companies 199723645 Length: 45 mm; diameter: 6.0 mm
DePuy Synthes Companies 199723650 Length: 50 mm; diameter: 6.0 mm
DePuy Synthes Companies 199723740 Length: 40 mm; diameter: 7.0 mm
DePuy Synthes Companies 199723745 Length: 45 mm; diameter: 7.0 mm
DePuy Synthes Companies 199723750 Length: 50 mm; diameter: 7.0 mm
Securo Drain Dispomedica GmbH 1.33578 Size: 7 mm; Length of perforation: 15 cm; Total length: 80 cm; Reservior size: 150 ml
Sterile 0.9% Sodium Chloride Solution Beijing SanYao Science & Technology Development Co. 15935S Volume: 500 mL
Straight rod DePuy Synthes Companies 1797-62-480 Length: 480 mm; diameter: 5.5 mm
Streptomycin sulfate, Powder Beijing SanYao Science & Technology Development Co. P06-11025P Size: 1 g
DOWNLOAD MATERIALS LIST

Referenzen

  1. Rubach, M. P., Halliday, J. E., Cleaveland, S., Crump, J. A. Brucellosis in low-income and middle-income countries. Current Opinion in Infectious Diseases. 26 (5), 404-412 (2013).
  2. Atluri, V. L., Xavier, M. N., de Jong, M. F., den Hartigh, A. B., Tsolis, R. M. Interactions of the human pathogenic Brucella species with their hosts. Annual Review of Microbiology. 65, 523-541 (2011).
  3. Tan, K. -. K., et al. Full genome SNP-based phylogenetic analysis reveals the origin and global spread of Brucella melitensis. BMC Genomics. 16 (1), 93 (2015).
  4. Pappas, G., Papadimitriou, P., Akritidis, N., Christou, L., Tsianos, E. V. The new global map of human brucellosis. The Lancet Infectious Diseases. 6 (2), 91-99 (2006).
  5. Harman, M., Unal, &. #. 2. 1. 4. ;., Onbaşi, K. T., Kıymaz, N., Arslan, H. Brucellar spondylodiscitis: MRI diagnosis. Clinical Imaging. 25 (6), 421-427 (2001).
  6. Lee, H. J., Hur, J. W., Lee, J. W., Lee, S. R. Brucellar spondylitis. Journal of Korean Neurosurgical Society. 44 (4), 277-279 (2008).
  7. Pourbagher, A., et al. Epidemiologic, clinical, and imaging findings in brucellosis patients with osteoarticular involvement. AJR American Journal of Roentgenology. 187 (4), 873-880 (2006).
  8. Ulu-Kilic, A., et al. Update on treatment options for spinal brucellosis. Clinical Microbiology and Infection. 20 (2), 75-82 (2014).
  9. Araj, G. F. Update on laboratory diagnosis of human brucellosis. International Journal of Antimicrobial Agents. 36, 12-17 (2010).
  10. Alp, E., Doganay, M. Current therapeutic strategy in spinal brucellosis. International Journal of Infectious Diseases. 12 (6), 573-577 (2008).
  11. Solís García del Pozo, J., Solera, J. Systematic review and meta-analysis of randomized clinical trials in the treatment of human brucellosis. PLoS One. 7 (2), 32090 (2012).
  12. Nas, K., et al. Management of spinal brucellosis and outcome of rehabilitation. Spinal Cord. 39 (4), 223-227 (2001).
  13. Chelli Bouaziz, M., Ladeb, M. F., Chakroun, M., Chaabane, S. Spinal brucellosis: a review. Skeletal Radiology. 37 (9), 785-790 (2008).
  14. Gregori, F., et al. Treatment algorithm for spontaneous spinal infections: A review of the literature. Journal of Craniovertebral Junction and Spine. 10 (1), 3-9 (2019).
  15. Lener, S., et al. Management of spinal infection: a review of the literature. Acta Neurochirurgica. 160 (3), 487-496 (2018).
  16. Sansalone, C. V., et al. Anterior approach to the spine. Role of the general surgeon, techniques and surgical complications. The 10-year experience of the Niguarda Hospitals. Journal of Neurosurgical Sciences. 55 (4), 357-363 (2011).
  17. Gao, L., Guo, R., Han, Z., Liu, J., Chen, X. Clinical trial reporting. Lancet. 396 (10261), 1488-1489 (2020).
  18. Tu, L., et al. Imaging-assisted diagnosis and characteristics of suspected spinal Brucellosis: A retrospective study of 72 cases. Medical Science Monitor. 24, 2647-2654 (2018).
  19. Zhao, Y. T., Yang, J. S., Liu, T. J., He, L. M., Hao, D. J. Sclerosing vertebra in the spine: typical sign of spinal brucellosis. Spine Journal. 15 (3), 550-551 (2015).
  20. Yang, X., Zhang, Q., Guo, X. Value of magnetic resonance imaging in brucellar spondylodiscitis. La Radiologia Medica. 119 (12), 928-933 (2014).
  21. Buzgan, T., et al. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. International Journal of Infectious Diseases. 14 (6), 469-478 (2010).
  22. Bai, Y., Qiao, P. F., Gao, Y., Niu, G. MRI characteristics of brucellar spondylodiscitis in cervical or thoracic segments. Biomedical Research-Tokyo. 28, 7820-7825 (2017).
  23. Katonis, P., Tzermiadianos, M., Gikas, A., Papagelopoulos, P., Hadjipavlou, A. Surgical treatment of spinal brucellosis. Clinical Orthopaedics and Related Research. 444, 66-72 (2006).
  24. Yang, B., Hu, H., Chen, J., He, X., Li, H. The evaluation of the clinical, laboratory, and radiological findings of 16 cases of Brucellar spondylitis. BioMed Research International. 2016, 8903635 (2016).
  25. Liang, C., Wei, W., Liang, X., De, E., Zheng, B. Spinal brucellosis in Hulunbuir, China, 2011-2016. Infection and Drug Resistance. 12, 1565-1571 (2019).
  26. Merloz, P., et al. Fluoroscopy-based navigation system in spine surgery. Proceedings of the Institution of Mechanical Engineers, Part H. 221 (7), 813-820 (2007).
  27. Foley, K. T., Simon, D. A., Rampersaud, Y. R. Virtual fluoroscopy. Operative Techniques in Orthopaedics. 10, 77-81 (2000).
  28. Foley, K. T., Simon, D. A., Rampersaud, Y. R. Virtual fluoroscopy: computer-assisted fluoroscopic navigation. Spine. 26, 347-351 (2001).
  29. Kang, K., et al. Partial facetectomy for lumbar foraminal stenosis. Advances in Orthopedics. , 534658 (2014).
  30. Bostian, P. A., et al. Novel rat tail discitis model using bioluminescent Staphylococcus aureus. Journal of Orthopaedic Research. 35 (9), 2075-2081 (2017).
  31. Scott, M. A., et al. Brief review of models of ectopic bone formation. Stem Cells and Development. 21 (5), 655-667 (2012).
  32. Li, T., Liu, T., Jiang, Z., Cui, X., Sun, J. Diagnosing pyogenic, brucella and tuberculous spondylitis using histopathology and MRI: A retrospective study. Experimental and Therapeutic Medicine. 12 (4), 2069-2077 (2016).
  33. Foley, K. T., Gupta, S. K. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. Journal of Neurosurgery. 97, 7-12 (2002).
  34. Verma, K., Boniello, A., Rihn, J. Emerging techniques for posterior fixation of the lumbar spine. Journal of the American Academy of Orthopaedic Surgeons. 24 (6), 357-364 (2016).
  35. Stoker, D. L., Jain, S. K., Jain, S. K., Stoker, D. L., Tanwar, R. Drains in Surgery. Basic Surgical Skills and Techniques. , (2018).
  36. Bridwell, K. H., Lenke, L. G., McEnery, K. W., Baldus, C., Blanke, K. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects. Spine. 20 (12), 1410-1418 (1995).
  37. Abulizi, Y., Liang, W. -. D., Muheremu, A., Maimaiti, M., Sheng, W. -. B. Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral brucellosis. BMC Surgery. 17 (1), 82 (2017).
  38. Ioannou, S., et al. Efficacy of prolonged antimicrobial chemotherapy for brucellar spondylodiscitis. Clinical Microbiology and Infection. 17 (5), 756-762 (2011).
  39. Herren, C., et al. Spondylodiscitis: diagnosis and treatment options. Deutsches Arzteblatt International. 114 (51-52), 875-882 (2017).
  40. Erdem, H., et al. Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter “Backbone-1 Study”. Spine Journal. 15 (12), 2509-2517 (2015).
  41. Garg, B., Kandwal, P., Nagaraja, U. B., Goswami, A., Jayaswal, A. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis. Indian Journal of Orthopaedics. 46 (2), 165-170 (2012).
  42. Bian, Z., Gui, Y., Feng, F., Shen, H., Lao, L. Comparison of anterior, posterior, and anterior combined with posterior surgical treatment of thoracic and lumbar spinal tuberculosis: a systematic review. Journal of International Medical Research. 48 (2), 300060519830827 (2019).
  43. Yan, D. -. L., Pei, F. -. x., Li, J., Soo, C. -. l. Comparative study of PILF and TLIF treatment in adult degenerative spondylolisthesis. European Spine Journal. 17 (10), 1311-1316 (2008).
  44. Schwender, J. D., Holly, L. T., Rouben, D. P., Foley, K. T. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. Journal of Spinal Disorders and Techniques. 18, 1-6 (2005).
  45. Rouben, D., Casnellie, M., Ferguson, M. Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion: a clinical and radiographic follow-up. Journal of Spinal Disorders and Techniques. 24 (5), 288-296 (2011).
  46. Chen, Y., et al. One-stage surgical management for lumbar Brucella spondylitis by posterior debridement, autogenous bone graft and instrumentation: a case series of 24 patients. Spine. 42 (19), 1112-1118 (2017).
  47. Choma, T., Pfeiffer, F., Vallurupalli, S., Mannering, I., Pak, Y. Segmental stiffness achieved by three types of fixation for unstable lumbar spondylolytic motion segments. Global Spine Journal. 2 (2), 79-86 (2012).

Tags

Keywords: Brucellar SpondylodiscitisBrucellosisSpinal InfectionDiagnosisSurgical TreatmentTransforaminal DecompressionDebridementInterbody FusionInternal Fixation
check_url/de/61840?article_type=t

Play Video
PDF
DOI
DOWNLOAD MATERIALS LIST
Diesen Artikel zitieren
Abulizi, Y., Cai, X., Xu, T., Xun, C., Sheng, W., Gao, L., Maimaiti, M. Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis. J. Vis. Exp. (171), e61840, doi:10.3791/61840 (2021).
Zitat herunterladen
Nachdrucke und Berechtigungen

View Video

✖

To prove you're not a robot, please enter the text in the image below

CAPTCHA Image
Play CAPTCHA Audio
Refresh Image