布鲁杆菌脊柱炎误诊为脊柱结核21例临床分析

Clinical Analysis of 21 Cases of Spinal Brucellosis Misdiagnosed as Spinal Tuberculosis

目的探讨布鲁杆菌脊柱炎的临床特点、误诊为脊柱结核的原因及防范措施。方法回顾性分析布鲁杆菌脊柱炎误诊为脊柱结核21例的临床资料。结果本组临床表现为全身关节酸痛20例,持续性胸、腰及背部疼痛19例,局部压痛、叩击痛19例,间断发热、乏力19例,食欲不振14例,神经根放射痛8例,盗汗、消瘦5例。术前均误诊为脊柱结核,误诊时间7 d^13个月,病变累及腰椎18例,胸椎2例,颈椎1例。21例均行病灶清除术,皆经术后病理检查确诊布鲁杆菌脊柱炎。予抗布鲁杆菌治疗2周,19例发热症状消失,15例腰痛症状明显减轻。继续治疗12周后所有患者临床症状均消失。随访6个月患者预后良好,未复发。结论布鲁杆菌脊柱炎临床表现复杂多样,早期易误诊。综合分析临床表现及血清学、影像学、病理学检查结果可与脊椎结核相鉴别。

Objective To investigate the clinical characteristics of spinal brucellosis and analyze cause of misdiagno-sis and formulate the relevant measures to prevent misdiagnosis. Methods The clinical data of 21 cases of spinal brucellosis patients misdiagnosed as spinal tuberculosis were retrospectively analyzed. Results The clinical manifestations in all cases were joints pain （20 cases）, persistent chest, pocket and back pain （19 cases）, local tenderness and taps（19 cases）, inter-mittent fever and fatigue （19 cases）, loss of appetite（14 cases）, radiating pain of nerve root （8 cases）, night sweating and angular （5 cases）. All the cases were misdiagnosed as spinal tuberculosis imaging examination in early stage before operation. The time of misdiagnosis was 7 days to 13 months. Lesions involved lumbar vertebra in 18 cases, thoracic vertebra in 2 cases, and cervical vertebra in 1 case. All cases were confirmed as spinal brucellosis by operation and pathological examination. Af-ter anti-brucellosis treatment for 2 weeks, sweating disappeared in 19 cases, and pocket pain was relieved in 15 cases. After continuous treatment for 12 weeks all the cases were clinically cured. No patients had recurrence and （ or） complications dur-ing a 6-month follow up. Conclusion The spinal brucellosis tends to be misdiagnosed as spinal tuberculosis in early stage for its complex and changeable clinical features. The spinal brucellosis may be diagnosed based on brucellosis clinical manifesta-tions, imaging characteristics, pathologic examination and serologic test.