胸腰椎结核的诊断(附39例报告)

The Diagnosis of Thoracolumbar Spinal Tuberculosis Analysis of 39 Cases

目的:探讨胸腰椎结核的诊断及鉴别诊断,减少误诊率。方法:2004年1月～2007年12月本科收治入院诊治的腰椎结核39例,通过回顾性研究门诊次数,明确诊断的时限,全身中毒症状,早期单纯腰僵痛,腰僵痛合并腿痛,混合感染,早期X-ray特点,CT、MRI特点,诊断性治疗等探索明确诊断的规律。结果:门诊次数超过3次(25/39)64.1%;门诊时限>2月(15/39)38.5%;全身中毒症状(14/39)35.9%;腰僵痛(30/39)76.9%;腰僵痛合并腿痛(29/39)74.4%;混合感染(6/39)15.4%;早期X-ray阴性(36/39)92.3%;CT明确诊断(30/39)76.9%;MRI明确诊断率(36/39)92.3%。结论:目前胸腰椎结核的早期症状不典型,早期诊断及鉴别诊断对于疾病的治疗和预后、医患关系具有重要意义;MRI对于早期诊断脊柱结核具有重要价值。

Objective：To explore the diagnosis and differential diagnosis of thoraeolumbar spinal tuberculosis （TST） so as to reduce the misdiagnosis rate. Methods： A retrospective study was done in 39 patients with TST who were treated in our hospital from January 2004 to December 2007. The following data were collected and analyzed： hospital attendance, time for diagnosis, systemic toxic symptoms, back pain and stiffness at early stage, back pain and stiffness accompanied with leg pain, mixed infection, early X-ray features, characteristics of CT and MRI, diagnostic treatment and so on. Results：Twenty-five patients out of 39 （64.1%） visited the hospital more than three times. It took 15 patients （38.5 %） more than 2 months to be clearly diagnosed. As for clinical symptoms, 14 showed systemic toxic symptoms （35.9%）, 30 had back pain and stiffness （76.9%）, 29 presented back pain and stiffness accompanied with leg pain （74.4%）. Mixed infections were found in 6 patients （15.4%）. X-ray gave negative information in 36 patients at the early stage （92.3%）, while CT clarified the diagnosis in 30 patients （76.9%） and MRI in 36 （92. 3 %）. Conclusion：Thoracic and lumbar tuberculosis do not present typical symptoms at the early stage. Thus, early diagnosis and differential diagnosis are especially important for the treatment and prognosis of the disease as well as for the doctor-patient relationship. MRI is of great value for early diagnosis of spinal tuberculosis.