布鲁菌性脊柱炎误诊为结核性脊柱炎15例临床分析  

Clinical Analysis of 15 Patients with Brucellar Spondylitis Misdiagnosed as Having Tuberculous Spondylitis

作　　者：伍彦辉 赵国芳 孙家桂 周丽红[1] 郭立杰[1] 陈静 WU Yan-hui;ZHAO Guo-fang;SUN Jia-gui;ZHOU Li-hong;GUO Li-jie;CHEN Jing(Department of Radiology,the Fifth Hospital of Shijiazhuang City,Shijiazhuang 050000,China;Department of Radiology,the Second Hospital of Shijiazhuang City,Shijiazhuang 050000,China;Department of Imaging,the Third Hospital of Quyang County,Quyang,Hebei 073100,China;Department of Radiology,the 980th Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China)

机构地区：[1]石家庄市第五医院放射科,石家庄050000 [2]石家庄市第二医院放射科,石家庄050000 [3]曲阳县第三医院影像科,河北曲阳073100 [4]解放军联勤保障部队第九八○医院放射科,石家庄050082

出　　处：《临床误诊误治》2021年第5期6-10,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨布鲁菌性脊柱炎误诊为结核性脊柱炎的原因及防范措施,并对二者的临床特点及鉴别诊断要点进行分析。方法对2016年5月—2020年5月收治的曾误诊为结核性脊柱炎的布鲁菌性脊柱炎15例的临床资料进行回顾性分析。结果本组误诊率为12.5%。3例曾患肺结核,1例有结核接触史。出现间断发热和乏力15例,全身酸痛和胸腰背部疼痛伴局部叩击痛各13例,神经根放射痛8例,盗汗和消瘦6例,脊柱后凸及运动障碍3例,睾丸疼痛和肿胀2例。15例均行CT和MRI检查,均曾误诊为结核性脊柱炎,误诊时间8 d~15个月。15例按误诊疾病行相关治疗症状改善不明显,进一步行相关检查等确诊为布鲁菌性脊柱炎,其中3例实施病灶清理加植骨融合内固定术,术中行快速冷冻病理检查符合布鲁菌性脊柱炎病理改变。15例予规范抗布鲁菌病治疗后病情缓解,治疗结束后1、3、6和12个月进行随访,皆预后良好,无复发。结论结合病史、临床表现及实验室、影像学、病理学检查结果综合全面对患者病情进行分析在布鲁菌性脊柱炎与结核性脊柱炎鉴别诊断中有重要意义,可降低误诊率。Objective To investigate causes and preventive measures of brucellar spondylitis(BS)misdiagnosed as tuberculous spondylitis(TS),and to analyze clinical characteristics and the main points for differential diagnosis of BS and TS.Methods Clinical data of 15 BS patients who had been misdiagnosed as having TS during May 2016 and May 2020 was retrospectively analyzed.Results The misdiagnosis rate of this group was 12.5%.Three patients had tuberculosis history,and one had history of contact with tuberculosis.Intermittent fever and fatigue were found in 15 patients;13 patients had muscular stiffness,while pain in chest,waist and back associated by local percussion pain were found in 13 patients;8 patients had radiating pains of nerve roots;sweating and emaciation were found in 6 patients;3 patients had kyphosis and dyskinesia,and testicular pain and swelling were found in 2 patients.All 15 patients were misdiagnosed as having TS after CT and MRI examinations.Misdiagnosed duration ranged from 8 d to 15 months.The 15 patients'symptoms were not improved after corresponding treatment for misdiagnosed diseases,and then BS was confirmed after further examination.Among them,3 patients were treated with focus cleaning and bone graft fusion and internal fixation,and quick freezing pathological examination was in line with the pathological changes of BS.Symptoms of 15 patients relieved after standard anti-brucellosis treatments.All the patients had good prognosis without recurrence in the 1 st,3 rd,6 th and 12 th months of follow-up after treatment.Conclusion It is of great significance in differential diagnosis of BS and TS to comprehensively analyze each patient's condition in combination with the history,clinical manifestations,laboratory,imaging and pathological examination results,which can reduce the misdiagnosis rate.

关 键 词：脊柱炎 布鲁菌病 误诊 结核 脊柱 

分 类 号：R681.51[医药卫生—骨科学] R516.7[医药卫生—外科学]