关节结核延误诊断的原因分析

Cause analysis for delayed diagnosis of joint tuberculosis

目的探讨关节结核的临床特点,以提高其诊疗水平。方法对2013年2月至2016年2月收治的关节结核109例的临床资料进行回顾性分析。结果本组关节结核患者85.32%(93/109)为中青年,50.46%(55/109)合并肺结核,病灶以膝41.28%(45/109)、踝14.68%(16/109)、髋12.84%(14/109)居多。临床主要表现为局部疼痛和活动受限,首诊误诊率74.31%(81/109)。本组根据症状体征,结合实验室各项化验检查、影像学检查、是否合并身体其他部位结核、脓肿穿刺、实验室检查、手术活检及诊断性抗结核治疗是否有效的综合手段最终明确诊断。最终通过全身抗结核药物及局部换药治愈16例,手术治愈66例,治愈率100%。结论关节结核早期临床表现隐匿、实验室检查的不确定性、影像学检查的局限性以及临床医师对该症状的认识不足,是延误诊断的主要原因。临床早期综合检查和必要的诊断性治疗是目前关节结核诊疗的基本方法。

Objective To explore the clinical characteristic of joint tuberculosis patients in order to improve the diagnosis of the joint tuberculosis.Methods The clinical data of 109 joint tuberculosis patients admitted to Shenzhen the third people's hospital of orthopedics for treatment were collected and retrospectively analyzed.Results The joint tuberculosis frequently urred in young and middle aged adults in this group(85.32%,93/109));55 cases(50.46%,55/109)were secondary to tuberculosis;the lesions were found mainly in knee 41.28%(45/109)cases,ankle14.68%(16/109)cases and hip 12.84%(14/109)cases.The major clinical manifestations were local pain and limited activity.The initial misdiagnosis rate of joint tuberculosis patients was 74.31%(81/109).The joint tuberculosis was confirmed relying on the symptoms and signs,laboratory tests,imaging examination,other involvement of tuberculosis,abscess puncture,laboratory examination,surgical biopsy and efficiency of diagnostic anti-tuberculosis treatment.Finally,16 cases were cured by anti-tuberculosis drugs and 66 cases were cured by surgery,with the cure rate of 100%.Conclusion Non-obvious early clinical manifestation,nondeterminacy of laboratory examination,limitation of imaging examination are the main reasons of misdiagnosis for joint tuberculosis.Comprehensive utilization of various tuberculosis specialized examination and the diagnostic anti-tuberculosis treatment are still the basic method for the diagnosis and treatment of joint tuberculosis.