强直性脊柱炎陈旧性骨折15例误诊分析及文献复习

Analysis on 15 cases of ankylosing spondylitis old fracture misdiagnosis and literature review

目的探讨强直性脊柱炎陈旧性骨折的临床表现、诊断及影像学特点。方法回顾性分析2011年1月至2019年1月西安交通大学附属西安市红会医院脊柱外科15例强直性脊柱炎陈旧性骨折误诊为脊柱结核患者的临床资料,观察其临床表现及影像特点。结果15例患者平均年龄(43.47±10.15)岁,平均误诊时间(4.53±1.30)个月,男13例,女2例;7例患者有既往外伤史。15例患者均误诊为脊柱结核,11例于外院行抗结核治疗症状无缓解。15例患者均可见异常影像改变,MRI示病变椎体混杂密度影,部分可见椎旁软组织炎性信号影。穿刺活检和术中病检结果为非特异性炎性细胞、退化的纤维化骨髓内软骨和增生纤维血管组织。结论强直性脊柱炎患者新发背痛需考虑脊柱骨折,及时进行临床和影像学评估,尤其注意与脊柱结核仔细鉴别,必要时进行有创检查,避免漏诊、误诊。

Objective To investigate the clinical manifestations,diagnosis and imaging characteristics of ankylosing spondylitis old fracture.Methods The clinical data in 15 cases of ankylosing spondylitis old fracture admitted in the spinal surgery of the Affiliated Xi′an Red Cross Hospital of Xi′an Jiaotong University from January 2011 to January 2019 were retrospectively analyzed,and their clinical manifestations and imaging characteristics were observed.Results The average age in 15 cases was(43.47±10.15)years old,the average misdiagnosis time was(4.53±1.30)months,13 males and 2 females;7 cases had a history of trauma.All cases were misdiagnosed as spinal tuberculosis,and 11 cases conducted the anti-tuberculosis treatment in the external hospital without symptom relief.Fifteen cases had abnormal imaging changes.MRI showed the mixed density shadow in the involved vertebra,and paravertebral soft tissue inflammatory signal shadow could be seen in some cases.The puncture biopsy and intraoperative pathological examinations showed the non-specific inflammatory cells,degenerative fibrocartilage,and proliferative fibrous vascular tissue.Conclusion For the ankylosing spondylitis patients with newly onset of backache,which needs to consider spinal fracture.Timely conducting clinical and imaging evaluation,especially pay attention to carefully differentiate from vertebral tuberculosis,the invasive examination is conducted when necessary for avoiding misdiagnosis and missed diagnosis.