脊柱布鲁氏菌属感染与脊柱结核的鉴别诊断

Differential diagnosis of spinal Brucella infection with spinal tuberculosis

目的分析脊柱布鲁氏菌属感染与脊柱结核的鉴别诊断,寻找其诊断鉴别方法,对疾病的诊断提供参考依据。方法回顾性分析医院2013年2月-2014年2月收治的34例疑似脊柱结核患者,对其应用64层双螺旋CT进行检查,观察并记录CT检查结果,同时病理取样进行确诊鉴别,所有数据采用SPSS18.0统计软件进行分析。结果 34例疑似脊柱结核患者经CT检查提示确诊者32例,占94.12%,32例患者均有明显的骨质破坏,有24例可见死骨,其中椎体整体构架破坏,骨质碎片涉及椎体外的碎骨片型病例有5例,椎体整体发生大部溶骨性骨质破坏的病例有1例,其余检出局灶破坏硬化型26例;另有2例患者CT检查无死骨形成、骨质边缘性缺损破坏,提示为脊柱布鲁氏菌属感染;34例疑似脊柱结核患者经病理取样确诊均为脊柱结核病,CT检查误诊率为5.88%。结论脊柱结核病的CT影像学表现较为复杂多样、特异性不强,尤其与脊柱布鲁氏菌属感染的CT影像学表现较为相似,因此非常容易发生两种疾病的混淆以及误诊,临床应增强疾病诊断水平,以防止误诊的发生。

OBJECTIVE To analyze the differential diagnosis of spinal Brucella infection with spinal tuberculosis and seek the differential diagnosis methods so as to provide guidance for the diagnosis of the diseases .METHODS A to‐tal of 34 patients with suspected spinal tuberculosis ,who were treated in the hospital from Feb 2013 to Feb 2014 were retrospectively analyzed ,then the 64‐layer pairs of spiral CT examination was performed ,the results of the CT examination were observed and recorded ,the pathological sampling was carried out for the differential diagno‐sis ,and all the data were statistically analyzed by using SPSS18 .0 software .RESULTS The CT examination indica‐ted that among the 34 patients with suspected spinal tuberculosis , 32 cases were confirmed , accounting for 94 .12% ,the 32 cases had remarkable bone destruction ,and 24 cases had visible sequestra ,among whom 5 cases had the vertebral body destruction of overall framework ,bone fragments involving extrapyramidal type of bone chips ,and 1 case had the osteolytic bone destruction in vertebral body ,26 cases had the focal damage sclerosis . The CT examination also showed that 2 cases did not have the formation of sequestra or bone defect edge damage , indicating that the patients were infected with spinal Brucella .The pathological sampling showed that the 34 pa‐tients with suspected spinal tuberculosis were identified as the spinal tuberculosis ,and the misdiagnosis rate of the CT examination was 5 .88% .CONCLUSION The CT imaging findings of the spinal tuberculosis were diversified , the specificity is not strong ,they are similar to the CT imaging findings of the spinal Brucella infection ,therefore , the two are prone to be confused and misdiagnosed .It is necessary to intensify the level of diagnosis of disease so as to avoid the misdiagnosis .