非特异性脊柱感染误诊为脊柱结核八例分析

Misdiagnosis Analysis of Eight Cases of Nonspecific Spinal Infections Misdiagnosed as Spinal Tuberculosis

目的探讨非特异性脊柱感染与脊柱结核的临床特点及鉴别诊断要点,减少误诊误治。方法回顾性分析南昌大学第一附属医院骨科2014年4月—2015年5月收治的误诊为脊柱结核的非特异性脊柱感染8例临床资料。结果 8例首发症状均为脊柱病变区域局部疼痛,3例伴低热,1例有脊柱外伤史。病程初期均误诊为脊柱结核,误诊时间2周-3个月。8例入我院后经术后病理和病原学检查确诊,其中金黄色葡萄球菌感染2例,大肠埃希菌、革兰阴性菌感染各1例,无菌生长4例。8例确诊后均给予敏感抗生素抗感染治疗,5例行病灶清除术,随访3-12个月,病情均有不同程度改善。结论非特异性脊柱感染与脊柱结核均可表现为病变区域疼痛,临床及影像学表现无特异性,易相互误诊,病理和病原学诊断可资鉴别。

Objective To investigate the clinical characteristics and differential diagnosis of nonspecific spinal infection and spinal tuberculosis so as to reduce misdiagnosis and mistreatment rates. Methods We retrospective analyzed 8 cases of nonspecific spinal infection misdiagnosed as spinal tuberculosis during April 2014 and May 2015 in the First Affiliated Hospital of Nanchang University. Results All the patients complained for local pain as initial symptom,with 3 cases combined with low-grade fever,and one case had history of trauma. All the cases were misdiagnosed as spinal tuberculosis during initial stage. The misdiagnosis time was 2 weeks-3 months. All the patients were confirmed in diagnosis by pathological examination or pathogenic examination,2 cases were staphylococcus aureus infection,one case was escherichia coli and one case was gram-negative bacterium,the other 4 cases of germiculture was electronegative. All the cases were treated with antibiotics after diagnosis. 5 cases underwent focal debridement surgery. 8 patients were followed up for 3-12 months,and improvement was found in all the cases. Conclusion Nonspecific spinal infection and spinal tuberculosis mainly present regional pain,and can be easily misdiagnosed. The pathological examination or pathogenically examination is essential in diagnosis.