52例脊柱结核的误诊分析与治疗

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1、!中国人兽共患病学报2012289ChineseJournalofZoonoses959DOI!10.3969"CZ..issn.1002-2694.2012.09.02152例脊柱结核的!"分析与#$林章雄!叶君健!陈宣维!陈春永!谢其扬摘!要!目的!通过对我院52例脊柱结核的误诊分析#提高临床医师对脊柱结核的认识#降低误诊率$方法!对我院2005-2011年收治的257例脊柱结核患者中52例误诊病例进行综合分析$结果!2例误诊为颈椎病#2例误诊为颈肩筋膜炎#4例误诊为肋间神经炎#3例误诊为棘上或棘间韧带炎#13例误诊为腰肌

2、劳损#8例误诊为腰椎间盘突出症#13例误诊为椎体肿瘤#7例误诊为骨质疏松及压缩性骨折%给予抗结核及手术治疗后49例痊愈#3例复发$结论!提高对脊柱结核临床特点的认识#重视体检和影像学表现#拓宽诊断思路#以减少误诊率$关键词!结核%脊柱%诊断%误诊!!中图分类号!R681.5文献标识码!B文章编号!1002-2694$2012%09-0959-04Analysisandtreatmenton52misdiagnosedcasesofspinaltnbercnlosisLINZhang-xiongYEJun-jianCHENXua

3、n-weiCHENChun-yongXIEGi-yangDePartmentofOrthoPaedicstheFirstAffiliated~osPitalofFujianMedicalUniUersit$Fuzhou350004ChinaABSTRACTThemisdiagnosisofspinaltuberculosiswasanalyzedinordertoimprovetheunderstandingofspinaltubercu-losisandreducethemisdiagnosedrate.acomprehen

4、siveanalysiswasconductedonclinicaldatafrom52misdiagnosedcasesoutof257patientswithspinaltuberculosisadmittedintoourhospitalduring2005-2011.ofthe52misdiagnosedpatientswithspinaltuberculosis2casesweremisdiagnosedascervicalspondylosis2casesasneckandshoulderfasciitis4cas

5、esasinter-costalneuritis3casesassupraspinousorinterspinousligamentinflammation13casesaslumbarmusclestrain8casesaslumbarintervertebraldischerniation13casesasvertebraltumorand7casesasosteoporosisandcompressionfractures.andafteranti-Tbandsurgicaltreatment49casesrecover

6、edand3casesrecurred.It'ssuggestedthatattentionshouldbepaidtotheclinicalfeaturesofspinaltuberculosisandthemisdiagnosticratecouldbereducedbyemphasizingtheimportanceofphysicalexaminationandtheimagingperformance.!!KEYWORDStuberculosisspinediagnosismisdiagnosisCorrespond

7、ingauthorYeJun-jianEmailyejunjian＠medmail.com.cn!!近年来结核病的发病率呈上升趋势其中脊例年龄18～77岁平均年龄49.8115.7岁发病1柱结核占骨关节结核50%左右脊柱结核由于到本次确诊时间1个月～7年平均7.8个月病变早期缺乏诊断特异性当病史临床特征X线平片发生于颈椎4例胸椎17例腰椎31例其中5例所见不典型时则给诊断和治疗带来一定的困难很侵犯骰椎病变范围局限于单个椎体3例侵犯2容易造成误诊误治待到确诊时已造成严重后果如个连续椎体47例跳跃侵犯椎体2例来自农村小出现脊柱骨质

8、严重破坏神经严重受损甚至截瘫城镇38例占73.1%本组病9例既往有肺结核病我院2005-2011年共收治脊柱结核病人257例其史占17.3%1例合并肾结核中52例发生误诊本研究就52例脊柱结核患者的1.2!临床症状与体征!本组病例均有局部疼痛其误诊以及治疗情况回顾总结如下中有