| Objective To explore the characteristics and clinical features of brucellar spondylitis(BS)in different periods,and to improve the understanding of BS,so as to provide assistance for clinical diagnosis and treatment.Methods Collected the demographic characteristics,clinical manifestations,laboratory examinations and imaging data of patients with BS who were diagnosed and treated by the Department of Spinal Orthopaedics,General Hospital of Ningxia Medical University from January 2011 to December 2017.According to the "Twelfth Five-Year" national key book "Practical Orthopaedics" and related literature,the BS patients according to the duration of the disease course are divided into acute period(0 to 3 months),subacute period(3 to 12 months)and chronic period(> 12 months).Based on this,we grouped and compared the clinical features of BS in different periods.Results A total of 201 patients with BS met the inclusion criteria,including 102 patients(50.75%)in the acute period,59 patients(29.35%)in the subacute period,and 40 patients(19.90%)in the chronic period.1.Demographic characteristics: There are 142(70.6%)male patients and 59(29.4%)female patients,the ratio of male to female is 2.41:1;The mean age of all the patients was 53.21±10.94 years old(range,20-73 years old),and the median age is 53 years old,the high peak of those patients was from 40 to 69 years old(170 cases,accounting for 84.58%).The mean age of male group was 52.19±11.38 years old which was slightly younger than female group(55.66±9.42 years old)(P<0.05).The majority of patients were farmers and herdsmen(74.13%),with occupational distribution characteristics;among them,139(69.15%)patients had a history of exposure to cattle and sheep.2.Clinical manifestations: The clinical manifestations of patients with BS are complicated and diverse,but most of them visiting doctor because of the mainly severe pain in the lower back.Some patients may be accompanied by symptoms such as fever,fatigue,sweating,signs of nerve damage,and chills.In our research,the fever,fatigue and sweating were statistically significant in the three groups(P<0.05).There were significant differences between the acute and chronic phases(P<0.0167)but there were no significant difference between the acute phase and subacute phase and the subacute phase and the chronic phase(P>0.0167).3.Laboratory examination: All the patients complete Brucella agglutination test were positive;The mean values of hs-CRP and ESR were higher than normal in the three groups.There was no significant difference in the mean value and positive rate of ESR between the three groups(P>0.05).,but has significant difference of hs-CRP(P<0.05)and the positive rates has a statistically significant difference between acute and chronic phase(P<0.0167).There are 77 patients has Adult blood culture examination,the positive rate was 27.3%(21/77),the acute positive rate was 40.4%(19/47),the subacute group had no positive result(0/19),and the chronic group was 18.2%(2/11).The difference between the three groups was statistically significant(P<0.05).There was significant difference between the acute group and the subacute group(P<0.0167),but no significant difference between the chronic group(P>0.0167).4.Imaging characteristics: Lumbar vertebrae is the most common involvement site(321 / 432,74.30%),followed by cervical vertebrae,thoracic vertebrae and sacral vertebrae.The lesions are mainly infected in single-segment(158/201,78.60%),multiple segments,cross-segments and single vertebrae infection accounted for(21.40%).ALL groups of patients have bone destruction,osteosclerosis,paraspinal abscess formation,intraspinal abscess formation,intervertebral space stenosis,intervertebral disc destruction,ligament calcification and other manifestations.By comparing the results of three groups of DR,it was found that the bone destruction in the acute group was lighter,and sometime there was no obvious abnormality in DR,but the bone destruction was more serious in the subacute and chronic groups.Therefore,the detection rate of DR in subacute and chronic group is higher than that in acute group(P<0.0167).The results of MRI showed that patients with acute and subacute group were more likely to develop intraspinal abscess,which was more common in patients with chronic group(P<0.0167).There were no significant differences in the other indexes between DR,CT and MRI(P>0.05).Conclusion1.There are more males than females in BS patients,and the peak age of onset is 40-69 years old.Most of them visited the doctor in the acute period,mainly farmers and herdsmen,and often have a history of contacted with livestock and livestock products;2.Patients with clinical manifestations of low back pain,undulant fever,sweating,fatigue,and signs of nerve damage should be considered BS.3.ESR and hs-CRP are highly sensitive but low in specificity,so it is necessary to combine SAT to confirm the diagnosis.4.The lesions range of BS is mainly single-segment infection,and the common invasive site is lumbar vertebrae;In the acute period,there is no obvious abnormal change in DR examination.Therefore,CT and MRI should be further improved for patients suspected of BS. |
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