非特异性脊柱感染误诊分析并文献复习  

Misdiagnosis Analysis of Non-specific Spinal Infection and Literature Review

作　　者：王韬[1] 吴佳宏 马朋朋[1] 宗治国[1] 刘肃[1] WANG Tao;WU Jia-hong;MA Peng-peng;ZONG Zhi-guo;LIU Su(Department of Orthopedics,the First Hospital Affiliated to Hebei North University,Zhangjiakou,Hebei 075000,China;Department of Geriatrics,the First Hospital Affiliated to Hebei North University,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院骨科,河北张家口075000 [2]河北北方学院附属第一医院老年医学科,河北张家口075000

出　　处：《临床误诊误治》2023年第2期15-18,22,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨非特异性脊柱感染的临床特点、鉴别诊断要点及误诊原因、防范措施。方法回顾性分析2018年2月-2021年3月收治的曾误诊为脊柱结核的非特异性脊柱感染13例的临床资料。结果本组10例受累脊柱棘突及椎旁有较明显压痛,3例受累脊柱棘突及椎旁有轻度压痛;发热9例。病程2~5个月;颈椎2例,胸椎3例,腰椎8例;单一节段受累9例,2~3个节段受累4例。血白细胞和中性粒细胞升高各2例,红细胞沉降率均增快,C反应蛋白升高8例。影像学检查显示病变椎体骨质不同程度破坏,病变椎体椎间隙狭窄或稍窄;4例病变椎体终板缘呈“鸟嘴样”反应性增生;2例病变椎体旁小脓肿形成。本组发病初期皆误诊为脊柱结核,平均误诊时间2.4周,予相应治疗,症状控制不理想。5例行病变椎体穿刺病理检查,8例行手术后病理检查,均确诊为非特异性脊柱感染。本组确诊后均予抗感染治疗,其中5例行病灶清除术;随访3~12个月,病变椎体疼痛较前明显缓解,相应指标皆恢复正常。结论发热、病变椎体进行性疼痛加剧、炎性因子升高、影像学检查示病变椎体骨质破坏等症状不足以诊断非特异性脊柱感染,易与脊柱结核混淆。临床上对此类患者应综合病史、临床表现、实验室指标和影像学表现等进行诊断,必要时行病变椎体穿刺或手术病理检查。Objective To investigate the clinical characteristics,differential diagnosis,causes of misdiagnosis and preventive measures of non-specific spinal infection.Methods The clinical data of 13 patients with non-specific spinal infection who were admitted to our hospital from February 2018 to March 2021 and initially misdiagnosed as spinal tuberculosis were retrospectively analyzed.Results Ten patients had obvious tenderness in the spinous process and paravertebral area,and 3 patients had mild tenderness in the spinous process and paravertebral area.Fever was found in 9 cases.The course of disease in this group was 2-5 months.There was infection in cervical spine(2 cases),thoracic vertebra(3 cases),and lumbar spine(8 cases).There were 9 cases of single level involvement and 4 cases of 2-3 level involvement.Leukocytes and neutrophils increased in 2 cases,erythrocyte sedimentation rate increased,and C-reactive protein increased in 8 cases.Imaging examination showed that the bone of the diseased vertebra was destroyed to varying degrees,and the vertebral space of the diseased vertebra was narrow or slightly narrow.Four cases showed"beak like"reactive hyperplasia along the endplate margin of the diseased vertebra,and small abscess formation of the diseased vertebra was observed in 2 cases.In this group,the initial stage of the disease was misdiagnosed as spinal tuberculosis,and the average duration of misdiagnosis was 2.4 weeks.Corresponding treatment led to unfavorable outcomes.Five patients underwent puncture pathological examination of the diseased vertebra and 8 patients underwent postoperative pathological examination,all of which were confirmed as non-specific spinal infection.All the patients received anti-infection treatment after diagnosis,5 of whom underwent debridement.After 3 to 12 months of follow-up,the pain of the diseased vertebra was significantly relieved,and the corresponding indexes all returned to normal.Conclusion Fever,progressive pain of the diseased vertebra,elevated inflammatory factors,bone dest

关 键 词：非特异性脊柱感染 误诊 结核 脊柱 鉴别诊断 细菌培养 病理学检查 

分 类 号：R681.51[医药卫生—骨科学]