脊柱原发性化脓性感染误诊原因分析

Misdiagnosis Analysis of Primary Pyogenic Spondylitis

目的探讨脊柱原发性化脓性感染的误诊原因及预防对策。方法对我院收治并误诊的脊柱原发性化脓性感染11例的临床资料进行回顾性分析。结果本组病变位于胸椎2例,腰椎9例;均在院外误诊,误诊为胸(腰)椎结核7例,腰椎间盘突出症3例,腰椎转移瘤1例。入我院初4例误诊为胸(腰)椎结核。本组5例保守治疗成功;6例行手术治疗,其中2例行经腹膜后入路切开病灶清除术,4例行一期腰椎后路椎弓根系统固定、侧前方入路病灶清除术。随访10～24月,平均18个月,未见复发。结论脊柱原发性化脓性感染容易误诊,MRI检查可提供较多鉴别诊断信息,及时行腰椎穿刺活检是尽早明确诊断的关键。

Objective To explore the causes of misdiagnosis and preventive measures of primary pyogenic spondylitis Methods 11 misdiagnosed patients with primary pyogenic spondylitis admitted into our hospital were analyzed retrospectively. Results The position of infection was at thoracic spine in 2 cases and at lumbar spine in 9 cases. All were misdiagnosed prior to hospitalization. 7 cases were misdiagnosed for spinal tuberculosis, 3 cases for lumbar disc herniation and 1 case for metastatic tumor. 4 cases were misdiagnosed for spinal tuberculosis after admission. The conservative management with antibiotic therapy was successful in 5 cases and the other 6 cases underwent surgical procedures. Focus clearance was done through retroperitoneal approach in 2 cases, 4 cases via anterolateral approach accompanied with posterior approach internal fixation. The period of follow-up lasted from 10 months to 24 months （mean = 18 months）. There was no recurrence. Conclusion Primary pyogenic spondylitis is easily misdiagnosed. MRI can provide more information for differential diagnosis. Puncture biopsy plays a key role in early diagnosis.