腕手部腱鞘结核临床误诊分析  

Clinical Misdiagnosis Analysis of Tuberculosis of Tendon Sheath in the Wrist and Hand

作　　者：王力[1] 杨山辉 霍永鑫[2] 瞿龙 孙福斋 吴学强[3] 孙汝涛[3] WANG Li;YANG Shanhui;HUO Yongxin;QU Long;SUN Fuzhai;WU Xueqiang;SUN Rutao(The Third Department of Joint,the Second Hospital of Tangshan City,Tangshan,Hebei 063000,China;the Second Department of Hand Surgery,the Second Hospital of Tangshan City,Tangshan,Hebei 063000,China;the Third Department of Hand Surgery,the Second Hospital of Tangshan City,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市第二医院关节三科,河北唐山063000 [2]唐山市第二医院手二科,河北唐山063000 [3]唐山市第二医院手三科,河北唐山063000

出　　处：《临床误诊误治》2024年第21期6-10,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省2023年度医学科学研究课题(20231731)。

摘　　要：目的探讨腕手部腱鞘结核临床误诊原因及防范措施。方法回顾性分析2023年4月至2024年4月收治的曾误诊的腕手部腱鞘结核3例的临床资料。结果1例右腕肿痛,拇指肿痛,根据相关检查结果及术后病理检查“腕部考虑滑膜炎,拇指考虑骨髓炎,结核不排除”,因腕部肿胀、疼痛加重再次入院,考虑结核。行抗结核治疗病情得到控制,出院诊断为“右腕手部腱鞘结核”。误诊时间3个月。外院继续抗结核治疗病情控制后行皮瓣手术治疗,随访未见结核复发,腕关节和屈指功能受限。1例左拇指掌侧肿物压痛加重、活动受限,考虑“指尖脓肿”,行指尖脓肿切开引流术后脓肿反复发作。结合病史及入院查体考虑“慢性感染”行扩创引流术,术后病理确诊为“手部腱鞘结核”。误诊时间11个月。确诊后行病灶清除术,随访未见结核复发,左拇指伸屈功能满意。1例左中指近节掌侧肿物,外院考虑为“狭窄性腱鞘炎”,予复方倍他米松注射液局部注射治疗,效果不佳。结合入院查体及相关检查结果,考虑结核感染,行病灶清除术,术后病理确诊为“手部腱鞘滑膜增殖型结核”。误诊时间14个月。确诊后行病灶清除术,随访未见结核复发,左手中指屈指活动功能满意。结论腕手部腱鞘结核因临床特征不典型,早期缺乏特异性诊断指标,误诊率较高,对长期对症治疗无效的腕手部病变应警惕腱鞘结核,尽早行病灶清除术及病理检查,以减少误诊。Objective To explore the causes of clinical misdiagnosis and preventive measures of tuberculosis of tendon sheath in the wrist and hand.Methods The clinical data of 3 patients with tuberculosis of tendon sheath in the wrist and hand who had been misdiagnosed from April 2023 to April 2024 were retrospectively analyzed.Results One patient had swollen wrist and sore thumb.According to relevant examination results and postoperative pathological examination,synovitis of the wrist and osteomyelitis of the thumb were considered,and tuberculosis was not excluded.The patient was re-admitted to hospital due to swelling and aggravating pain in the wrist,and tuberculosis was considered.The disease was controlled after anti-tuberculosis treatment,and the patient was diagnosed with tuberculosis of tendon sheath in the right wrist and hand.Misdiagnosis lasted 3 months.After disease control with anti-tuberculosis treatment,flap operation was performed in another hospital.No recurrence of tuberculosis was observed during follow-up,and the wrist joint function and flexion function were limited.A case of left thumb volar mass with increased tenderness and limited movement was considered to have fingertip abscess;however,fingertip abscess recurred after treatment with incision and drainage.Combined with the medical history and physical examination after admission,chronic infection was considered and debridement and drainage were performed;the postoperative pathology confirmed the diagnosis of tuberculosis of tendon sheath in the wrist.The misdiagnosis lasted 11 months.After diagnosis,the lesion was removed,and no recurrence of tuberculosis was found during follow-up.In addition,the flexion function of the left thumb was satisfactory.One patient with left middle finger proximal ganglion volar mass,which was considered as stenosing tenosynovitis in another hospital,was treated by local injection of Compound Betamethasone injection,but the effect was not good.Combined with physical examination after admission and relevant examination r

关 键 词：腕手部腱鞘结核 误诊 滑膜炎 骨髓炎 慢性感染 狭窄性腱鞘炎 结核菌素纯蛋白衍生物试验 

分 类 号：R686.1[医药卫生—骨科学]