误诊为Haglund综合征的强直性脊柱炎临床分析  

Clinical Analysis of Ankylosing Spondylitis Misdiagnosed as Haglund Syndrome

作　　者：张强 张旭日 师国洋 钱春生 邓伟哲 ZHANG Qiang;ZHANG Xuri;SHI Guoyang;QIAN Chunsheng;DENG Weizhe(Department of Traditional Chinese Medicine,the 962nd Hospital of the Joint Logistics Support Force of the PLA,Harbin 150048,China;Department of Rehabilitation Medicine,the 962nd Hospital of the Joint Logistics Support Force of the PLA,Harbin 150048,China)

机构地区：[1]联勤保障部队第九六二医院中医科,哈尔滨150048 [2]联勤保障部队第九六二医院康复医学科,哈尔滨150048

出　　处：《临床误诊误治》2024年第18期11-15,共5页Clinical Misdiagnosis & Mistherapy

基　　金：黑龙江省中医药科研项目(ZHY2024-021);哈尔滨市科技计划项目(ZC2023ZJ004022)。

摘　　要：目的探讨强直性脊柱炎(AS)误诊为Haglund综合征的原因及防范措施。方法回顾性分析2018至2024年收治的2例AS曾误诊为Haglund综合征患者的临床资料。结果2例均因反复发作足跟痛就诊,1例经CT和肌骨超声、1例经磁共振检查诊断为Haglund综合征,给予相应治疗症状无明显改善,完善人类白细胞抗原B27、红细胞沉降率和C反应蛋白检测及骶髂关节CT和磁共振检查后确诊AS。误诊时间均为1个月。确诊后给予非甾体抗炎药及生物制剂治疗,患者转归良好,随访病情稳定未复发。结论部分AS患者和Haglund综合征有相同的跟腱疼痛症状,但伴随症状不同,完善骶髂关节磁共振、人类白细胞抗原B27、红细胞沉降率和C反应蛋白检查,可提高早期诊断准确率,减少误诊。Objective To investigate the causes and preventive measures of misdiagnosis of ankylosing spondylitis(AS)as Haglund syndrome.Methods The clinical data of 2 patients with AS who had been misdiagnosed as Haglund syndrome from 2018 to 2024 were retrospectively analyzed.Results Both patients presented with repeated heel pain.One patient was diagnosed with Haglund syndrome by CT and musculoskeletal ultrasound,and 1 patient was diagnosed by magnetic resonance imaging(MRI).The symptoms did not improve significantly after corresponding treatment.AS was confirmed after performing relevant examinations including human leukocyte antigen B27,erythrocyte sedimentation rate(ESR),C reactive protein(CRP)test,and CT and MRI of the sacroiliac joint.The misdiagnosis lasted 1 month.After diagnosis,the patient was treated with NSAIDS and biologics.The patient's prognosis was good and follow-up showed stable condition without recurrence.Conclusion Several AS patients and patients with Haglund syndrome have the same symptoms of Achilles tendon pain,but different accompanying symptoms.Performing relevant examinations including the MRI of the sacroiliac joint,human leukocyte antigen B27,ESR and CRP test can improve the accuracy of early diagnosis and reduce misdiagnosis.

关 键 词：脊柱炎 强直性 误诊 Haglund综合征 人类白细胞抗原B27 红细胞沉降率 C反应蛋白 磁共振成像 

分 类 号：R593.23[医药卫生—内科学]