强直性脊柱炎63例误诊漏诊分析

Misdiagnosis Analysis of 63 Patients with Ankylosing Spondylitis

目的探讨强直性脊柱炎(ankylosing spondylitis,AS)的误诊原因,提高早期诊断率。方法回顾性分析我院2007年4月—2011年7月收治并误诊的强直性脊柱炎63例的临床资料。结果我院同期收治AS 121例,63例曾在外院及本院误诊,误诊率52.1%。本组因腰骶部疼痛误诊为腰椎间盘突出症16例,腰肌劳损8例;因四肢外周关节肿痛误诊为风湿性关节炎14例,类风湿关节炎7例,跟腱炎6例,跟骨骨刺4例,化脓性关节炎2例;因虹膜炎误诊为单纯性虹膜炎1例;5例未明确诊断。结论加强对AS的认识,详细询问病史及家族史,认真查体,及时行骶髂关节CT检查、HLA-B27检测是早期诊断AS、降低误诊率的关键。

Objective To discuss the misdiagnosis cause of ankylosing spondylitis （AS） so as to improve the early diagnosis rate. Methods Clinical data of 63 patients misdiagnosed as having ankylosing spondylitis in our hospital during April 2007 and July 2011 were rereospectively analyzed. Results 121 patients with AS were admitted to our hospital, among whom, 63 patients were misdiagnosed in our hospital and other hospitals, and the misdiagnosis rate was 52.1%. In this group, due to lumbosacral region pain, 16 patients were misdiagnosed as having lubar intervertebral disc protrusion and 8 patients, lumbar muscle strain; Due to limbs peripheral joint swelling, 14 patients were misdiagnosed as having rheumatic arthritis, 7 patients were misdiagnosed as having polyarthritis destruens, achilles tendinitis in 6 patients, 4 patients were misdiagnosed as having caleaneal spurs and suppurative arthritis in 2 patients; Lritis was diagnosed as simple iritis in one patient; 5 patients had no definite diagnosis. Conclusion It is important to fully understand AS and to ask medical history and family history in details. Physical examinations and the sacroiliac joint CT scanning and HIA-B27 testing are essential in early diagnosis and reducing misdiagnosis rate of AS.