老年病人原发性非特异性脊柱感染误诊病例分析

Analysis of Primary Nonspecific Spinal/nfection in Senile Misdiagnosed patients

目的：探讨老年患者原发性非特异性脊柱感染的临床特点和误诊因素，总结应对策略。方法：收集在外院误诊或我院误诊的老年原发性非特异性脊柱感染病例进行回顾性分析。结果：本组共有31例；男性13例，女性18例；年龄在60-83岁，平均71．3岁；在院外误诊17例，本院误诊14例；误诊为脊柱结核22例，椎间盘突出症5例，脊柱椎转移瘤4例。通过影像学检查提供病灶定位进行穿刺取材活检＋病原体培养及药物敏感试验指导诊治，终获治愈。其中保守治疗22例；手术治疗9例。随访13～51个月，平均26．7个月，未见复发。结果：老年原发性非特异性脊柱感染临床表现不典型，容易误诊；其基础疾病是原发性非特异性脊柱感染的危险因素；尽早根据CT、MR病灶定位进行病灶穿刺取材病理活检和（或）病原体培养及敏感试验是明确诊断和指导治疗的关键。

objectives： To study the clinical characteristics of senile patients with primary nonspecific spinal infection, risk factors of misdiagnosis and feasible strategies of diagnosis. Methods： Respectively analyzing senile patients with primary spinal pyogenic infection that were previously misdiaguosed. Results： There are totally 31 cases, male in 13 cases, female in 18 cases; age from 60 to 83 years, mean 71.3 years. Among these, 17 cases were misdiagnosed by other hospitals then came to our department, 14 cases were misdiagnosed in our department. There were misdiagnosed as spinal tuberculosis in 22 cases, intervertebral disc herniation in 5 cases, spinal vertebral metastases tumors in 4 cases. There are atypical clinical manifestations in senile patients with nonspecific infection. Athough laboratory in- flammation index and imaging examination can provide infection evidence and lesion localization, but no specific values in pathogens dif- ferentiating. These cases were finally correctly diagnosed based on biopsy and pathogen culture results. Based the drugs sensitive tests guiding treatment, there are successfully conservative treatment alone in 22 cases ; additional surgery treatment in 9 cases. All these cases were healed. Follow - up of these cases ranged from 13 to 51 months, an average of 26.7 months; no case relapsed. Conclusions： The senile patients with primary nonspecific spinal infection were easily misdiagnosed because of clinical atypical manifestations. Elderly pa- tients with other systematical diseases is the risk factor for primary nonspecific spinal infection. Laboratory tests such as white blood cell counting, c - reactive protein, erythrocyte sedimentation rate and procalcitonin can provide evidence of infection; CT and MRI can provide information of accurate lesion location. These evidences and informations guiding to biopsy and pathogen culture and sensitivity test is the key process to correctly diagnose and guide treatment. In addition, biopsy specimens properly preserved and tested as soon as possible is the assurance of an ideal result.