非典型性脊柱结核的临床诊治

Diagnosis and treatment for atypical spinal tuberculosis

目的分析非典型脊柱结核的临床、影像特点及治疗方法。方法对27例非典型脊柱结核患者的病史、临床及影像检查特点、治疗方法进行分析总结。结果初诊时9例被误诊为腰背肌劳损,2例颈椎病,3例下腹部肿物;3例椎间盘突出;6例误诊为脊柱转移瘤,4例误诊为非结核性感染。经CT、MRI或穿刺活检检查有脊柱结核的特征性表现,抗结核化疗及手术治疗后恢复良好。结论非典型性脊柱结核缺乏典型的临床表现,平片中骨质破坏不明显,在门诊常为误诊误治。CT、MRI检查及CT引导下的穿刺活检可对该病早期诊断,正规的抗结核化疗及病椎部分切除植骨内固定手术治疗效果满意。

Objective To analyze surgical diagnosis and treatment of atypical spinal tuberculosis. Methods 27 cases of atypical forms of spinal tuberculosis were reviewed with regard to history, clinical manifestation, imaging features and treatment. Results 9 cases of the 27 patients were misdiagnosed as back muscle strain; 2 cases as cervical spondylodc myelopathy;3 cases as tumor in low abdomen; 3 cases as dischemiation; 6 cases as spinal metastases; 4 cases as othersInfection. They were confimed by CT, MRI or biopsy specimens confirmed them.Anti-TB chemotherapy and surgical treatment have a good result.Conclusion The atypical spinal tuberculosis have neither the typical clinical nor the radiographic appearance.It can beMisdiagnosed or mistreated easily.Radiographic techniques.Including computed tomography.magnetic resonance imaging,and CT guided biopsy were helpful in early establishing the diagnosis of such conditions.Satisfactory clinical results can be achieved by anti-tubercular chemotherapy and partial excision of pathologc vertebrae.spinal fusion and internal fixation.