JoVE Journal > Medicine
Summary
Abstract
Introduction
Protocol
Results
Discussion
Disclosures
Acknowledgements
Materials
References
Automatic Translation
Medicine

Diagnose og kirurgisk behandling af human Brucellar Spondylodiscitis

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

Vi beskriver en klinisk algoritme, baseret på årtiers front-line erfaring med diagnose og kirurgisk behandling af menneskelige Brucellar spondylodiscitis i det største medicinske center i Kinas Xinjiang Pastoral Area.

Abstract

Brucellar spondylodiscitis (BS) er den mest udbredte og betydelige osteoarticular præsentation af human Brucellosis, som er almindeligt manifesteret i pastorale samfund. Det er svært at differentieret diagnosticere og fører normalt til irreversible neurologiske underskud og spinal deformiteter. Den første diagnose af BS er baseret på kliniske fund og radiografiske vurderinger, og den bekræftede diagnose bør fastslås ved, at Brucella-arter isoleres fra blod- og/eller standardrørs agglutinationsprøven. Differentialdiagnosticering af multifokal BS fra enten degenerative disksygdomme eller tuberkulose fremhæves især. Den kirurgiske tilgang, enten endoskopisk eller åben, demonstreres i detaljer, ledsaget af radiografiske tegn på strukturel kompression eller alvorlig ustabilitet. Desuden forklares de afgørende kirurgiske trin, herunder transforaminal dekompression i enkelttrin, debridement, interstoffusion og intern fiksering. Desuden behandles perioperativ pleje og postoperativ rehabilitering også. Samlet set præsenterer denne kliniske algoritme en praktisk vejledning, der har givet væsentligt tilfredsstillende resultater i de seneste årtier, som også kan introduceres til storstilet anvendelse til styring af menneskelig BS, især i endemiske regioner.

Introduction

Med mere end en halv million nye tilfælde årligt, menneskelig brucellose er blevet et folkesundhedsproblem og er fortsat en enorm byrde på verdensplan1,2,3,4. BS, som den mest almindelige og alvorlige osteoarticular manifestation af human brucellose, involverer flere strukturer, herunder hvirvellegemer, intervertebral disk og paraspinale strukturer5,6. Det forekommer ofte i lumbosacralzonen og skal skelnes fra andre smitsomme sygdomme på grund af dets uspecifikke kliniske egenskaber7,8. På trods af de betydelige fremskridt inden for forskning i de seneste årtier er nøjagtig og rettidig diagnose af BS stadig en udfordring for klinikere på grund af dets sene radiologiske fund, langsomme vækstrate i blodkulturer og kompleksiteten af dets serodiagnosis9. Derfor forbliver human BS klinisk underdiagnosticeret og underrapporteret. Selv om der i de seneste årtier er sket stadig hurtigere fremskridt i indførelsen og populariseringen af flere terapeutiske retningslinjer, er der stadig ingen konsensus om en optimal ledelsesmodalitet10. Hyppige tilbagefald, behandlingssvigt og sequelae rapporteres konstant11.

Det skal bemærkes, at BS kan være alvorligt invaliderende og invaliderende, selvom det sjældent er dødeligt. Hvis det ikke behandles korrekt, kan mulige alvorlige følgevirkninger induceres, herunder vedvarende rygsmerter, neurologisk mangel og endda kyfotisk deformitet12,13. Antibiotikabehandling er kernen i behandlingen af BS og giver generelt lovende resultater9. Visse patienter kan dog kræve kirurgisk behandling, hvis neurologisk dysfunktion, spinal ustabilitet, bylddannelse, genstridige smerter eller en tidligere utilfredsstillende reaktion på konservative behandlinger observeres. Kirurgisk indgreb er stadig kontroversielt. Forskellige kirurgiske procedurer for debridement og fusion er blevet beskrevet for smitsomme sygdomme i lændehvirvelsøjlen, herunder forreste kun, posterior-only, og kombineret tilgange14,15,16. Her er diagnostiske retningslinjer blevet præsenteret for human BS og for enkelttrins kirurgisk behandling med transforaminal dekompression, debridement, interstoffusion og intern fiksering via en efterfølgende tilgang. En detaljeret protokol over denne metode er angivet nedenfor.

Protocol

Undersøgelsen blev godkendt af det etiske udvalg af first affiliated Hospital of Xinjiang Medical University, Kina17. 1. Informeret samtykke Opnå patientens informerede samtykke efter at have forklaret detaljerne i den kirurgiske procedure, postoperativ prognose og mulige komplikationer (infektion, epidural hæmatom, rygmarvsskade, svigt i intern fiksering og cerebrospinal væskelækage). Forklar de andre risici, der generelt er forbundet med at br…

Representative Results

Dette papir beskriver en prospektiv, ikke-randomiseret, kontrolleret undersøgelse af 32 på hinanden følgende BS-patienter, der blev behandlet af en enkelt-trins transforaminal dekompression, debridement, interbody fusion, og intern fiksering via en posterior-only tilgang i Department of Spine Surgery, Første Tilknyttet Hospital i Xinjiang Medical University, Urumqi, Kina. Figur 1 viser et typisk tilfælde i denne undersøgelse. <p class="jove_content"…

Discussion

Den nuværende retningslinje for diagnosticering og kirurgisk behandling af human BS med en detaljeret protokol og tilfredsstillende klinisk dokumentation fra repræsentative kohorter viser klinisk effekt og foreslås til storstilet anvendelse til styring af human BS, især i endemiske regioner. Det første kritiske skridt i behandlingen af BS er at stille den korrekte diagnose. Diagnosen BS skal skelnes fra spinaltuberkulose, sammenlignet med hvilken BS er relativt mindre knogledestruktiv og reagerer normalt effektivt p…

Disclosures

The authors have nothing to disclose.

Acknowledgements

Dr. Xiaoyu Cai anerkender den økonomiske støtte fra Kina Scholarship Council. Dette arbejde blev finansieret af Natural Science Foundation of Xinjiang-provinsen, P. R. China (nr. 2016B03047-3).

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
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Tags

Brucellar SpondylodiscitisBrucellosisSpinal InfectionDiagnosisSurgical TreatmentTransforaminal DecompressionDebridementInterbody FusionInternal Fixation

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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).
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