非牧区综合性医院布鲁菌性脊柱炎七例临床误诊分析  

Clinical Misdiagnosis of Brucobacterial Spondylitis in a General Hospital in a Non-pastoral Area:An Analysis of 7 Cases

作　　者：胡鹏[1] 沈雄杰[1] 李灏宸 HU PENG;SHEN Xiongjie;LI Haochen(Department of Spinal Surgery,the First Affiliated Hospital of Hu'nan Normal University Hu'nan People's Hospital,Changsha 410000,China)

机构地区：[1]湖南师范大学附属第一医院、湖南省人民医院脊椎外科,长沙410000

出　　处：《临床误诊误治》2024年第1期24-28,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨布鲁菌性脊柱炎误诊脊柱结核的原因,以提高非牧区综合性医院布鲁菌性脊柱炎早期确诊率。方法回顾性分析2019年6月—2021年6月收治的布鲁菌性脊柱炎早期误诊脊柱结核7例的临床资料。结果7例均有近期牧区旅游史及牛羊接触史;1例有肺结核病史;病变部位:腰椎5例、胸椎2例;就诊前均曾自服解热镇痛药物。7例均持续性胸腰背疼痛伴活动受限、间断发热、乏力,全身关节游走性疼痛6例,食欲不振5例,脊柱局部压痛、叩击痛3例;肝脾大3例,颈淋巴结增大2例,睾丸疼痛1例。7例均初步诊断为脊柱结核。详细追问病史得知患者均有近期牧区旅游或出差史,行结核三项检查均阴性排除结核病,行布鲁菌血清学检测、虎红平板凝集试验及血清凝集试验均阳性,确诊布鲁菌性脊柱炎。误诊时间10~12 d。确诊后予利福平联合多西环素和(或)头孢曲松抗布鲁菌治疗患者症状均消失,随访半年预后良好。结论非牧区综合性医院布鲁菌性脊柱炎接诊率极低,接诊医师警惕性低,病史询问不详细,加之结核病史及解热镇痛类药物使用干扰诊断,使得容易误诊脊柱结核。非牧区综合性医院接诊医师应加强对该地区少见病的认识,提高警惕性,详细追问相关病史,尽早完善相关医技检查,综合分析病情,仔细鉴别诊断,以降低本病早期误诊率。Objective To investigate the causes of misdiagnosis of brucellosis spondylitis(BS)as spinal tuberculosis,so as to improve the early diagnosis rate of BS in general hospitals in non-pastoral areas.Methods The clinical data of 7 patients with BS misdiagnosed with spinal tuberculosis in early stage admitted to hospital from June 2019 to June 2021 were retrospectively analyzed.Results All the 7 patients had recent travel history and contact history of cattle and sheep in pastoral areas,including 1 patient with a history of pulmonary tuberculosis.Lesion sites included lumbar spine(5 cases)and thoracic spine(2 cases).All patients had self-administered antipyretic and analgesic drugs before treatment.All of the 7 patients had persistent chest,waist and back pain with limited movement,intermittent fever and weakness,and there was systemic joint wandering pain in 6 patients,loss of appetite in 5 patients,local spinal tenderness and tapping pain in 3 patients,hepatosplenomegaly in 3 patients,cervical lymph node enlargement in 2 patients,and testicular pain in 1 patient.All the 7 cases were diagnosed as spinal tuberculosis.Detailed follow-up of medical history revealed that all patients had a recent history of travel or business trips in pastoral areas,and three tests for tuberculosis were negative to rule out tuberculosis.Brucella serological test,tiger red plate agglutination test and serum agglutination test were positive,and BS was confirmed.The duration of misdiagnosis was 10-12 days.After diagnosis,the symptoms of patients treated with Rifampicin combined with Doxycycline and(or)Ceftriaxone disappeared,and the prognosis was favorable after six months of follow-up.Conclusion The diagnosis rate of BS in general hospitals in non-pastoral areas is very low,the vigilance of attending physicians is low,the history of tuberculosis is not detailed,and the use of antipyretic and analgesic drugs interferes with the diagnosis,which makes it more likely to be misdiagnosed as spinal tuberculosis.The attending doctors of general ho

关 键 词：脊柱炎 布鲁菌病 误诊 脊柱结核 流行病史 发热 腰痛 鉴别诊断 

分 类 号：R681.51[医药卫生—骨科学]