恶性肿瘤腰椎转移误诊为腰椎间盘突出症19例分析

Clinical Analysis of 19 Cases of Malignancy Diagnosed as Syndrome of Lumbar Disc Herniation

目的：探讨误诊为腰椎间盘突出症的恶性肿瘤晚期腰椎转移的临床特点。方法：对1980-2005年6053例以腰椎间盘突出症入院，确诊为恶性肿瘤19例的临床资料进行归纳分析。结果：11例夜间痛明显，13例局部叩击痛。19例均摄腰椎X线片，示腰椎骨质破坏3例；16例行CT检查均发现椎间盘突出，骨质破坏2例；10例行腰椎MRI检查示9例腰椎局部骨质破坏。实验室检查：红细胞沉降率增高3例，碱性磷酸酶增高2例。14例穿刺活检确诊，5例经ECT全身骨扫描确诊。结论：腰椎间盘突出症的诊疗过程中，如无明显诱因出现明显腰部酸胀样疼痛，夜间剧烈，局部叩击痛，疼痛渐进性加重，红细胞沉降率明显增高而无其他炎性疾病，需考虑恶性肿瘤晚期腰椎转移的可能性，需行腰椎MRI、ECT全身骨扫描检查或穿刺活检，避免误诊误治。

Objective：To explore the characteristics of malignancy patients diagnosed as syndrome of lumbar disc herniation to avoid false diagnosis and false therapy. Methods ：6 053 cases from the year 1980 to 2005 in the hospital, were collected and diagnosed as syndrome of lumbar disc herniation,out of which, 19 cases were diagnosed as malignancy. Results：There were 11 cases with severe pain at night and 13 cases with local spine knocking pain. Lumbar X-ray image examination showed 3 cases with osseous destruction, 16 cases were found with lumbar disc herniation in CT scanning,2 cases with osseous destruction, out of the 10 cases who accepted MRI examination,9 cases showed lumbar osseous destruction. Laboratory test showed 3 cases with increased ESR and 2 cases with increased alkalescence phosphoestrase. Conclusion ： In the diagnosis of lumbar disc herniation, if there are obvious symptom of clear night pain and local spine knocking pain and aggravated pain and increased ESR without obvious lenitive posture infection, possibility of malignancy should be considered and lumbar MR/test should be made.