强直性脊柱炎13例误诊分析

Causes of Misdiagnosis of Ankylosing Spondylitis in 13 Cases

目的分析强直性脊柱炎(ankylosing spondylitis,AS)的临床特点及诊治方法,减少误诊误治。方法回顾性分析我院收治的13例误诊为其他疾病的AS临床资料,并复习相关文献。结果所有患者均有高强度训练史,其中3例有明确外伤史;因训练后腰背部疼痛伴晨僵就诊5例,因训练后腰腿痛就诊3例,因腰部及臀部疼痛、外伤后腰背部疼痛就诊各2例,因腰部及髋部疼痛伴晨僵就诊1例;2例伴有关节外症状。脊柱叩击痛并活动受限8例,骶髂部压痛7例,Schober试验阳性9例,“4”字试验阳性6例,直腿抬高试验阳性5例。本组误诊时间9个月~7年,平均(17.80±25.42)个月,误诊为腰椎间盘突出症8例,误诊为腰肌劳损、软组织损伤各2例,误诊为骶髂关节损伤1例,均予相应处理。后根据患者症状、体征及骶髂关节影像学检查,确诊为AS,均予理疗、功能锻炼等常规治疗,其中1例予以口服中药治疗;12例予柳氮磺胺吡啶、甲氨蝶呤、塞来昔布等药物治疗,其中5例加用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白皮下注射。12例进行了随访,随访时间6个月~6年,其中1例出现腰骶部融合强直,11例病情稳定。结论AS起病隐匿,加之军人常因训练伤掩盖了AS的症状,且基层医师对炎性腰背痛认识不足,进而误诊。

Objective To analyze the clinical characteristics,diagnosis and treatment of ankylosing spondylitis(AS),and to reduce the rate of misdiagnosis and missed diagnosis.Methods A retrospective analysis was performed on the misdiagnosis of AS in 13 patients admitted to our hospital,and relevant literature was reviewed.Results All patients had a history of intensive training,and three had a history of trauma.Five patients presented with symptoms of lower back pain with morning stiffness,and 3 presented with symptoms of back and leg pain after training.Two patients presented with pain in the waist and hip and 2 patients presented with lower back pain due to trauma.One patient visited the doctor for symptom of lumbosacral pain and hip pain with morning stiffness.Two patients had extrarticular symptoms.There was percussion pain of spinal column and limited lumbar motion in 8 cases,sacroiliac tenderness in 7 cases.The Schober test was positive in 9 cases,Patrick sign was positive in 6 cases,and Lasegue sign was positive in 5 cases.The duration of misdiagnosis was 9 months to 7 years,with an average of(17.80±25.42)months.The misdiagnosed diseases included lumbar intervertebral disc protrusion in 8 cases,strain of lumbar muscles and soft tissue injury in 2 cases respectively,and sacroiliac joint damage in 1 case.All were given corresponding treatment.According to the symptoms and signs of the patients and the sacroiliac joint imaging examination,the patients were diagnosed as AS.All patients were given physical therapy,functional exercise and other conventional treatment,and one of the patients was given oral Chinese medicine treatment.Twelve cases were given drugs including sulfasalazine,Methotrexate,and Celecoxib,of whom 5 cases were injected subcutaneously with recombinant human type II tumor necrosis factor receptor antibody fusion proteins.Twelve of the patients were followed up for six months to six years.One patient developed lumbosacral fusion ankylosis,while the others were in stable condition.Conclusion AS patients have insidious onset,the symptoms of training injuries mask the symptoms of AS in soldiers,and the grassroots doctors are lack of knowledge of inflammatory low back pain,leading to misdiagnosis.