肩关节结核临床误诊分析  

Analysis of Clinical Misdiagnosis of Tuberculosis of Shoulder Joint

作　　者：杨松运[1] 李刚池[1] 张雷[1] 莫松全[1] 朱朝均 YANG Songyun;LI Gangchi;ZHANG Lei;MO Songquan;ZHU Chaojun(Department of Orthopaedics,Santai Hospital Affiliated to North Sichuan Medical College People's Hospital of Santai County,Santai,Sichuan 621100,China)

机构地区：[1]川北医学院附属三台医院三台县人民医院骨科,四川三台621100

出　　处：《临床误诊误治》2023年第8期26-30,共5页Clinical Misdiagnosis & Mistherapy

基　　金：四川省医学青年创新科研课题(Q20039)。

摘　　要：目的 探讨肩关节结核的临床特点及误诊原因。方法 回顾性分析2019年1月—2021年1月收治误诊的肩关节结核4例的临床资料。结果 4例因肩关节疼痛3个月~1年就诊,左肩2例,右肩2例;其中1例有肺结核病史,误诊为肩关节炎;1例误诊为肩关节滑囊炎伴细菌感染;1例误诊为肩关节色素沉着绒毛结节性滑膜炎;1例误诊为肩袖损伤行手术治疗,术后切口不愈合。误诊时间3个月~1年。4例均在关节镜下行病灶清理+闭式冲洗引流术,术后病理检查结果均证实为肩关节结核,正规服用抗结核药物,4例随访12个月肩关节功能评价量表评分80~95分。结论 肩关节结核诊断困难,漏误诊率高,临床医生应提高警惕,特别是对有结核病史的患者,应及早行病理检查以明确诊断,从而减少误诊。Objective To investigate the clinical features and causes of misdiagnosis of tuberculosis of shoulder joint.Methods The clinical data of 4 patients with tuberculosis of shoulder joint misdiagnosed in our hospital from January 2019 to January 2021 were retrospectively analyzed.Results Four patients presented with shoulder pain for 3 months to 1 year,including 2 in the left shoulder and 2 in the right shoulder.Of them,one patient had a history of tuberculosis and was misdiagnosed as shoulder arthritis.One patient was misdiagnosed as bursitis of the shoulder joint with bacterial infection,and one patient was misdiagnosed as pigmented villonodular synovitis of the shoulder joint.One patient was misdiagnosed as rotator cuff injury and underwent surgical treatment,but the incision did not heal after surgery.Misdiagnosis lasted from 3 months to 1 year.All the 4 cases underwent arthroscopic lesion cleaning+closed irrigation and drainage,and the postoperative pathological examination results confirmed tuberculosis of shoulder joint.Four patients were followed up for 12 months with regular use of anti-tuberculosis drugs,and the scores of shoulder joint function evaluation scale were 80-95 points.Conclusion It is difficult to diagnose tuberculosis of shoulder joint,and the rate of misdiagnosis is high.Clinicians should be vigilant,especially for patients with a history of tuberculosis,and pathological examination should be performed early to make a clear diagnosis,so as to reduce misdiagnosis.

关 键 词：结核 骨关节 肩关节 误诊 滑膜炎 色素绒毛结节性 细菌感染 结核分枝杆菌 抗结核药 关节镜检查 

分 类 号：R529.2[医药卫生—内科学]