强直性脊柱炎误诊为腰椎问盘突出症40例分析

Ankylosing spondylitis misdiagnosed as lumbar intervertebral disk hernia: An analysis of 40 cases

对４０例误诊为腰椎间盘突出症的强直性脊柱炎患者进行了分析，认为其误诊原因为：①临床拟诊错误，致使患者不能接受相应的Ｘ线平片及化验检查；②临床医生过于相信ＣＴ检查结果，忽视了病史及查体；③对坐骨神经痛的病因未能深入研究；④放射科医师对强直性脊柱炎的早期Ｘ线诊断缺乏经验。分析结果还表明，强直性脊柱炎多继发无症状性椎间盘膨出或突出，较少并发腰椎间盘突出症。治疗上前者主要应用抗风湿类药物辅以物理治疗，控制炎症发展，而后者需同时配合牵引及手法治疗。

Forty cases of ankylosing spondylitis (AS) misdiagnosed as lumbar intervertebral disk hernia (LIDH) were analysed.The misdiagnostic causes included:(1)mistaked clinical diagnosis enabling the patient not to receive the corresponding plain films and laboratory examinations;(2)clinical doctor too believing the results of CT scanning but overlooking the disease history and physical examination;(3 )no deep study on the cause of sciatica;( 4 )insufficient experiences of the radiologist in AS early X-ray diagnosis.Moreover,the analysed results suggested that AS is complicated with asymptomatic intervertebral disk hernia in most cases.but with LIDH in fewer cases. AS is treated mainly by antirheumatics,physiotherapy and controlling inflammation,while LIDH is treated by both traction and maneuvers.