脊柱感染误诊误治临床分析  

Clinical Analysis of Misdiagnosis and Mistreatment of Spinal Infections

作　　者：李建华 杨阳 王帅 常正奇 LI Jianhua;YANG Yang;WANG Shuai;CHANG Zhengqi(Department of Orthopedics,the 960th Hospital of Joint Logistics Support Force of the PLA,Jinan 250031,China)

机构地区：[1]联勤保障部队第九六〇医院骨病科,济南250031

出　　处：《临床误诊误治》2025年第3期1-5,共5页Clinical Misdiagnosis & Mistherapy

基　　金：山东省自然科学基金面上项目(ZR2023MH331)。

摘　　要：目的探讨脊柱感染误诊误治原因及防范措施。方法回顾性分析2022至2024年收治的2例椎体感染误诊为椎体压缩骨折并行椎体成形术后患者的临床资料及治疗经过。结果1例因误诊胸椎压缩骨折术后再发胸背部疼痛入院,于外院曾误诊为胸椎压缩骨折并行椎体成形术治疗。入院后给予相关医技检查,后行CT引导下穿刺并送病理检查确诊椎体感染。误诊时间14 d。确诊后完善术前准备后行跨越感染节段的椎弓根钉内固定术并病灶清除负压封闭引流技术(VSD)治疗,切口愈合良好;术后6个月复查X线,提示感染治愈。1例因误诊腰椎压缩骨折术后再发腰背痛入院,于当地医院曾误诊为腰椎压缩骨折并行椎体成形术治疗。入院后给予相关医技检查,后行经皮穿刺椎间孔镜手术,取部分脓液送病理检查确诊椎体感染。误诊时间4 d。行跨越感染节段的经皮螺钉内固定术并行病灶清除VSD治疗,术后1个月复查磁共振提示感染获得有效治疗。结论脊柱感染和骨质疏松性椎体压缩骨折在影像学上存在相似性,不易鉴别。因此临床医生应该根据患者情况及检查结果综合判断,必要时穿刺活检以明确诊断,减少误诊误治。Objective To explore the causes and preventive measures of misdiagnosis and treatment of spinal infection.Methods The clinical data and treatment process of 2 patients with vertebral infection who were misdiagnosed as vertebral compression fracture and underwent verteatoplasty from 2022 to 2024 were retrospectively analyzed.Results A patient was admitted to our hospital due to recurrent chest and back pain after surgery for misdiagnosed thoracic compression fracture which had been treated with vertebroplasty in another hospital.After admission,relevant medical examinations were given,and CT-guided puncture was performed for pathological examination,which confirmed the diagnosis of vertebral infection.Misdiagnosis lasted 14 d.After diagnosis and improvement of preoperative preparation,pedicle screw fixation across infected segments and lesion clearance with vacuum sealing drainage(VSD)were performed,and the incision healed well.X-ray examination at 6 months after surgery indicated that the infection had been cured.A patient was admitted to our hospital with recurrent low back pain after surgery for misdiagnosed lumbar compression fracture which had been treated by vertebroplasty in a local hospital.After admission,the relevant medical examination was performed,then percutaneous foraminal endoscopic surgery was performed,and part of the pus was sent for pathological examination to confirm the vertebral infection.The misdiagnosis lasted 4 d.Percutaneous screw fixation across the infected segment was performed,followed by lesion clearance+VSD.Reexamination with magnetic resonance imaging at 1 month after surgery indi-cated that the infection was effectively treated.Conclusion Spinal infection and osteoporotic vertebral compression fracture are similar on imaging and difficult to distinguish.Therefore,the clinician should make a comprehensive judgment according to the patient's condition and examination results,and biopsy should be performed if necessary to clarify the diagnosis and reduce misdiagnosis and mistreatmen

关 键 词：脊柱疾病 感染 误诊 骨质疏松性骨折 病理检查 椎弓根钉内固定术 负压伤口疗法 磁共振成像 

分 类 号：R681.5[医药卫生—骨科学]