Abstract：Objective To explore the value of MRI classifications in diagnosis and treatment for Brucella spondylitis disease.Methods The clinical data of 257 patients with Brucella spondylitis that confirmed by clinical and laboratory examination from January 2002 to July 2013 were analyzed retrospectively. These cases included 131 males and 126 females. The age ranged from 21 to 82, and the average age was (46.52±1.27). These cases were classified according to the MRI imaging manifestations, such as disease location, extent of inflammatory infiltration and damage in vertebrae and intervertebral space, paraspinal soft tissue changes, stability of the spine, spinal cord or cauda equina nerve root compression,etc. Treatments included non-surgical and surgical treatment, non-surgical treatment was simple medication (A group), surgical treatment include limitations of minimally invasive lumbar lesions(B group), cervical debridement and internal fixation(C group), thoracic lumbar bone debridement surgery(D group), and thoracic lumbar bone debridement and internal fixation(E group). The relativity of clinical treatment strategies and imageology classification judged by the clinical efficacy were evaluated and researched. The data were analyzed with consistency check of image analysis.Results In the 257 cases of Brucellosis spondylitis, there were 47 cases of type Ⅰ, 45 cases of Ⅱ type, 41 cases of type Ⅲ, 32 cases of type Ⅳ, and 92 cases of type Ⅴ. All the 257 cases included 241 cases of damage involving 2 vertebral bodies and 16 cases of damage involving 3 vertebral bodies. The highest incidence was in lumbar(63.36%, 168/257). Three months after treatment, 257 cases were reviewed. Six months after treatment, the review number was 212 cases (82.49%) which included 134 cases of surgical treatment, 78 cases of non-surgical treatment, 5 recurrence cases of A group(1 case of lumbar Ⅱ type, 2 cases of type Ⅲ and 2 cases of Ⅳ type), and 2 recurrence cases of B group(1 case of lumbar Ⅱ type and a case of Ⅳ type). The total 7 recurrence cases were instead treatment of group E. Twelve months after treatment, the review number was 173 cases (67.31%) which included 112 cases of surgical treatment, 61 cases of non-surgical treatment, and no recurrence cases. Whether early or late postoperative, spine stability and bone graft fusion occurred in all cases of group C and E. Among the 50 cases treated with intertransverse facet bone grafting in the group D (total 56 cases)included 19 cases (38%) of spine stability and bone graft fusion and 31 cases (62%) of bone graft absorption (After treatment group E, 16 cases with spinal instability and low back pain were spine stability and bone graft fusion). Image analysis agreement κ values were more than 0.75. Clinical efficacy displayed when compared a point in time after and before in each group, the differences of cure rate were statistically significant(all P values＜0.05). At the same time points, cure rates in group C and E were more than those in group A, B and D. The differences of cure rate were statistically significant between group D and E in 6 months or 12 months (all P values＜0.05 ).Conclusions MRI imaging classification of Brucellosis spondylitis has some characteristics and contributes to clinical diagnosis and differential diagnosis. Each has the appropriate treatment strategy, for examples, typeⅠis suitable for non-surgical treatment, typeⅡ and Ⅳ for minimal invasive, and type Ⅲ and Ⅴ for debridement and internal fixation.
杨新明, 孟宪勇, 胡长波, 贾永利, 张培楠, 王耀一, 张振梁, 成垚昱, 康聪, 任义行. MRI影像分型对布鲁杆菌病性脊椎炎的诊断与治疗价值[J]. 中华解剖与临床杂志, 2016, 21(2): 101-108.
Yang Xinming, Meng Xianyong, Hu Changbo, Jia Yongli, Zhang Peinan, Wang Yaoyi, Zhang Zhenliang, Cheng Yaoyu, Kang Cong, Ren Yixing.. The diagnosis and therapeutic value of MRI images typing for brucella spondylitis disease. Chinese Journal of Anatomy and Clinics, 2016, 21(2): 101-108.
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