【摘要】：[目的]探討腰椎布氏菌性脊椎炎病變椎間盤不同時期病理特點(diǎn)。[方法]2012年11月~2015年3月,88例行手術(shù)治療的腰椎布氏菌性脊柱炎患者,男72例,女16例,年齡40~68歲,平均52.6歲。76例行腰椎后路病灶清除、減壓、內(nèi)固定、植骨融合術(shù),12例行椎間孔鏡下病灶清除術(shù)。術(shù)前收集X線片、CT及MRI等影像資料,術(shù)中收集病變椎間盤,采用HE和Gimesa染色進(jìn)行病理觀察。[結(jié)果]X線片及CT顯示88例患者椎間盤均可見炎性改變,其中椎間盤破壞者84例,12例表現(xiàn)為早期椎間隙正�；蜉p度變窄,多為1~2個臨近椎體終板及終板下局灶性骨質(zhì)毀壞;76例表現(xiàn)為中晚期椎間隙明顯變窄,可累及大部分甚至整個椎體,表現(xiàn)為空洞、破壞、硬化、增生。MRI顯示12例早期病變椎間盤T1WI呈稍低信號或等信號,T2WI及壓脂T2WI呈不均勻混雜高信號,增強(qiáng)后不均勻強(qiáng)化;76例中晚期病變椎間盤T1WI呈低信號,T2WI及壓脂T2WI呈高信號,增強(qiáng)后明顯強(qiáng)化。病理結(jié)果示88例病變椎間盤均可見布魯氏菌Gimesa染色陽性;HE染色發(fā)現(xiàn)早期病變椎間盤大量炎癥細(xì)胞增殖,包含大量單核細(xì)胞、淋巴細(xì)胞、中性粒細(xì)胞、嗜酸性細(xì)胞,中晚期病變椎間盤纖維組織廣泛增生。[結(jié)論]腰椎布氏菌性脊椎炎病變椎間盤不同時期病理表現(xiàn)具有特征性,對臨床診斷和治療方案的選擇可提供重要的參考信息。
[Abstract]:[objective] to investigate the pathological characteristics of lumbar disc with brucellosis spondylitis. [methods] from November 2012 to March 2015, 88 patients (72 males and 16 females) with lumbar spondylitis treated surgically, aged 40 to 68 years (mean 52.6 years), underwent posterior lumbar debridement, decompression and internal fixation. Bone grafting and fusion were performed in 12 cases. X-ray films, CT and MRI were collected before operation, and disc lesions were collected during operation. HE and Gimesa staining were used for pathological observation. [results] Eighty-eight patients showed inflammatory changes in intervertebral disc by X-ray and CT, including 84 cases of disc destruction, 12 cases showed normal or slight narrowing of intervertebral space at early stage, most of them were 1 ~ 2 adjacent vertebral endplate and focal destruction of bone under endplate. 76 cases showed obvious narrowing of intervertebral space in middle and late stage, which could involve most or even the whole vertebral body, and showed cavitation, destruction, sclerosis and hyperplasia. MRI showed that T1WI of early lesion of intervertebral disc showed slightly low signal intensity or isointense signal in 12 cases. T2WI and T2WI were heterogeneous and mixed with high signal intensity, and enhanced inhomogeneously after enhancement. In 76 cases of middle and late stage disc, T1WI showed low signal intensity, T2WI and fat pressing T2WI showed high signal intensity, and enhanced obviously after enhancement. The pathological results showed that brucella Gimesa staining was positive in 88 cases. HE staining showed that a large number of inflammatory cells proliferated in the early stage of the disc, including a large number of monocytes, lymphocytes, neutrophils, eosinophils, and extensive proliferation of fibrous tissue of the intervertebral disc in the middle and late stage. [conclusion] the pathological manifestations of lumbar vertebrae with brucellosis are characteristic in different stages, which can provide important reference information for clinical diagnosis and treatment.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京地壇醫(yī)院骨科/感染病科國家臨床重點(diǎn)�？平ㄔO(shè)項(xiàng)目;首都醫(yī)科大學(xué)附屬北京地壇醫(yī)院病理科;
【分類號】：R681.5

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