【摘要】：研究背景 在國(guó)內(nèi),由于抗生素的廣泛使用,典型化膿性脊柱炎病例已較少見(jiàn),增加了早期診斷的困難。布氏桿菌病為人畜共患傳染病,其病變過(guò)程脊柱容易受侵犯進(jìn)而發(fā)展成為布氏桿菌脊柱炎。結(jié)核病雖然常發(fā)生于呼吸系統(tǒng),但骨關(guān)節(jié)結(jié)核并不罕見(jiàn),脊柱為其最好發(fā)位置,占骨關(guān)節(jié)結(jié)核總數(shù)的50%。早期脊柱炎癥在影像學(xué)及臨床表現(xiàn)上有諸多類(lèi)似之處,然而三者的治療卻完全不同。因此正確的早期診斷及鑒別診斷,及時(shí)有效的干預(yù)治療,能夠明顯減少患者脊柱畸形與功能損害的概率。如今,病理學(xué)檢測(cè)已作為常規(guī)檢查手段在臨床中應(yīng)用,MRI因其精確的顯示、多維顯像以及較好的軟組織分辨率是脊柱炎癥的首選檢查方法。為此,作者擬通過(guò)觀察病理組織顯微特點(diǎn)與MRI征象改變,探討病理學(xué)及MRI在早期脊柱炎癥鑒別診斷中的價(jià)值。 目的 通過(guò)觀察脊柱炎癥病理結(jié)果與MRI征象改變,探討病理學(xué)及MRI在早期脊柱炎癥鑒別診斷中的應(yīng)用價(jià)值。 方法 對(duì)22例化膿性脊柱炎、20例布氏桿菌脊柱炎、20例脊柱結(jié)核患者行CT引導(dǎo)下經(jīng)皮穿刺椎體活檢及MRI檢查,病理學(xué)切片觀察結(jié)果包括病變骨組織結(jié)構(gòu)及活力,組織細(xì)胞及其主要成分；MRI觀察結(jié)果包括病變部位、信號(hào)改變及征象變化。比較分析3組患者病理及MRI檢查結(jié)果的構(gòu)成比,統(tǒng)計(jì)方法為卡方檢驗(yàn)。 結(jié)果 下列結(jié)果中,化膿性脊柱炎組總體率最高,且差異有顯著性意義(P0.05)：嗜中性粒細(xì)胞浸潤(rùn)為主；椎間盤(pán)明顯異常信號(hào),椎體病變位置椎體前+后方,膿腫壁厚而不規(guī)則；下列結(jié)果中,布氏桿菌脊柱炎組總體率最高,且差異有顯著性意義(P0.05)：淋巴細(xì)胞浸潤(rùn)為主,新生骨組織,類(lèi)上皮樣肉芽腫組織,椎體病變位置椎體前方,椎體形態(tài)無(wú)明顯變化,椎旁軟組織無(wú)明顯異常信號(hào),無(wú)骨內(nèi)或椎旁膿腫形成,膿腫壁薄而不規(guī)則；下列結(jié)果中,脊柱結(jié)核組總體率最高,且差異有顯著性意義(P0.05)：死骨組織,朗格漢斯巨細(xì)胞,干酪樣壞死,病變部位位于下胸椎,椎間盤(pán)無(wú)明顯異常信號(hào),椎體后方病變,病變椎體形態(tài)明顯變化,椎旁軟組織明顯異常信號(hào),骨內(nèi)或椎旁膿腫形成,膿腫壁薄而光滑。 結(jié)論 通過(guò)對(duì)三種早期脊柱炎癥的病理學(xué)及MRI征象描述及比較,提示病理學(xué)及MRI在早期脊柱炎癥的鑒別診斷中具有較高價(jià)值。該鑒別思路對(duì)細(xì)菌培養(yǎng)陰性脊柱炎癥患者的診斷更有幫助。
[Abstract]:Background due to the widespread use of antibiotics, typical suppurative spondylitis cases have been rare in China, increasing the difficulty of early diagnosis. Brucellosis is a zoonotic disease. Although tuberculosis often occurs in the respiratory system, osteoarticular tuberculosis is not uncommon, the spine is the best location, accounting for 50% of the total bone and joint tuberculosis. Early spinal inflammation has many similarities in imaging and clinical manifestations, but the treatment of the three is completely different. Therefore, correct early diagnosis and differential diagnosis, timely and effective intervention can significantly reduce the probability of spinal deformity and functional damage. Nowadays, pathological examination has been used as a routine examination method in clinic because of its accurate display, multi-dimensional imaging and better soft tissue resolution, it is the preferred examination method for spondylitis. Therefore, the authors intend to investigate the value of histopathology and MRI in the differential diagnosis of early spinal inflammation by observing the histopathological features and the changes of MRI signs. Objective to investigate the value of pathology and MRI in the differential diagnosis of early spinal inflammation by observing the pathological results of spinal inflammation and the changes of MRI signs. Methods 22 cases of suppurative spondylitis and 20 cases of brucellae spondylitis and 20 cases of spinal tuberculosis were examined by CT guided percutaneous vertebra biopsy and MRI examination. MRI findings of histocyte and its main components include lesion location, signal changes and signs. The results of pathological and MRI examination were compared and analyzed in three groups. The statistical method was chi-square test. Results among the following results, the total rate of suppurative spondylitis was the highest, and the difference was significant (P0.05): neutrophilic granulocyte infiltration was dominant; The abscess wall was thick and irregular. The overall rate of Brucella spondylitis group was the highest, and the difference was significant (P0.05): lymphocytic infiltration, new bone tissue, epithelioid granulomatous tissue, anterior vertebral body lesion, There was no obvious change in the shape of vertebral body, no obvious abnormal signal in the paravertebral soft tissue, no intraosseous or paravertebral abscess, and the abscess wall was thin and irregular. Among the following results, the total rate of spinal tuberculosis group was the highest, and the difference was significant (P0.05): dead bone tissue, Langerhans giant cells, caseous necrosis, lesions located in the lower thoracic vertebrae, no obvious abnormal signal in the intervertebral disc, pathological changes in the posterior vertebral body, obvious changes in the shape of the lesion vertebrae, abnormal signals in the soft tissue around the vertebrae, intraosseous or paravertebral abscess, The wall of the abscess is thin and smooth. Conclusion through the description and comparison of pathological and MRI signs of three kinds of early spondylitis, it is suggested that pathology and MRI have higher value in differential diagnosis of early spondylitis. This method is helpful for the diagnosis of bacterial culture negative spondylitis.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R681.5;R445.2

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