血清阴性脊柱关节病误诊分析

目的：通过对血清阴性脊柱关节病(spondyloarthropathy，SpA)误诊情况分析，总结误诊原因，以提高SpA的康复治疗水平。方法：对东南大学附属中大医院风湿免疫科于1998—08／2003—11诊治的SpA进行回顾性统计和分析，总结SpA63例患者误诊原因。结果：本组SPA63例，误诊48例(76％)，有腰骶部酸痛或关节肿痛阳性家族史19例(40％)。临床表现为腰骶部酸痛、外周关节肿痛、肌踺韧带骨附着点痛、胸廓扩张度&;lt;2．5cm等，以腰骶部疼痛为首发症状29例(60％)；以外周关节肿痛为首发症状19例(40％)。HLA—B27阳性41例(85％)，骶髂关节CT示骶髂关节炎36例(75％)，20例摄外周关节X射线平片，均未见明显异常。所有误诊病例在本次确诊前均未查血清HLA—B27和骶髂关节CT。48例误诊的SpA被误诊为腰椎间盘突出症16例、肌筋膜炎或纤维织炎4例、腰肌劳损和棘上、棘间韧带损伤5例、慢性盆腔炎2例、致密性髂骨炎2例、化脓性关节炎7例、结核性关节炎1例、痛风2例、创伤性滑膜炎2例、类风湿关节炎7例。结论：SpA误诊主要与医生对SpA的临床特征了解较少，未仔细询问相关病史，未查血清HLA-B27和骶髂关节CT有关。     

幼年脊柱关节病18例分析

幼年脊柱关节病(JSPA)系指16岁以前发病的一组与HLA-B27相关的关节滑膜、肌腱端、腱鞘和滑囊临床状况、综合征和疾病[1].目前国内缺乏统一的诊断标准,使本病的早期诊断非常困难.对我们所遇18例回顾性分析如下.     

未分类脊柱关节病一例

1病历患者,女,15岁,因反复双膝、双肩关节疼痛5月入院,以左膝关节肿胀明显,间有低热,37~38℃。体查:蹒跚步态,左侧4字征阳性。曾住本院骨科行关节腔镜组织活检未见结核组织,关节腔液常规白细胞,血白细胞12.64×109/L,ESR 27 mm/h,RF、CCP抗体均为阴性,ANA、ds-DNA、ANCA均阴性,HLA-B27阴性。双肩、双膝、骶髂关节X线片均未见异常。曾诊断为风湿性关节炎、化脓性关节炎,抗炎、镇痛等治疗均无好转。本科认为患者主要表现为单个关节受累明显,无骶髂关节受累表现,RF、HLA-B27阴性,诊断为未分类血清阴性脊柱关节病,予小剂量激素、柳…     

未分化脊柱关节病52例分析

我们收集了我院1998~2006年间住院的未分化脊柱关节病(uSpA)患者52例,现加以分析如下。1临床资料1.1一般资料本组男30例,女22例,年龄15~42(平均31.6)岁,所有病例均符合Amor及ESSG诊断标准,但未确诊为强直性关节炎、赖特综合征、银屑病性关节炎、炎性肠病性关节炎及反应性关节炎等。1.2临床表现背痛40例,腰痛43例,臀区痛21例,膝关节疼痛25例,踝关节疼痛19例,足跟痛18例,虹膜炎2例,发热3例。1.3实验室检查52例患者中血沉增快41例,C反应蛋白升高23例,类风湿因子均呈阴性,ANA阴性,HLA-B27阳性32例。1.4影像学检查骶髂关节分级按1966年纽约…     

脊柱结核误诊33例分析

脊柱结核是常见的骨关节结核 ,文献报道约占所有骨关节结核的 4 7.2 8% ,其部位隐蔽 ,症状复杂 ,临床上常引起漏诊或误诊。我院 1989- 0 8～ 2 0 0 2 - 0 8共收治脊柱结核 110例 ,其中 33例曾在院外误诊。分析如下。1　临床资料本组男 13例 ,女 2 0例 ,年龄最大 78岁 ,最小 18岁 ,平均35岁 ,腰椎结核 13例 ,胸腰椎结核 14例 ,胸椎结核 6例。起病至确诊时间最长为 5 a,最短为 0 .5 a,平均 1.2 a。其中曾被院外误诊为风湿、类风湿病 15例 ,腰椎间盘突出症 4例 ,坐骨神经痛10例 ,腰肌劳损 3例 ,脓肿 1例。本组 33例经正规抗痨治疗后行病灶清除…     

脊柱结核误诊为脊柱肿瘤30例临床分析

目的:探讨非典型脊柱结核误诊为脊柱肿瘤的原因及鉴别诊断要点.方法:回顾分析我院经手术后病理证实的30 例非典型脊柱结核的临床资料,重点分析影像学误诊原因.结果:相邻椎体骨质、椎间盘破坏,椎间隙狭窄或消失、椎旁脓肿形成是脊柱结核典型的影像特征.30例手术治疗后均痊愈,术后并发切口感染2例,窦道形成1例.结论:本病临床表现缺乏特异性,对其影像特点认识不足、未进行必要的鉴别诊断是造成误诊的主要原因.     

夏科氏关节病16例误诊分析

目的:探讨夏科氏关节病的诊治方案及临床误诊原因.方法:对2001年9月至2009年9月首诊误诊的夏科氏关节病患者16例进行回顾性分析.结果:16例患者中,误诊15例,其中5例误诊为结核,类风湿性关节炎3例,创伤关节炎3例,肿瘤3例,髋关节发育异常1例.结论:忽视全面仔细的体格检查,对本病缺乏警惕,专业知识不强,满足于一般疾病诊断,是误诊的主要原因.     

非特异性脊柱感染误诊为脊柱结核八例分析

目的探讨非特异性脊柱感染与脊柱结核的临床特点及鉴别诊断要点,减少误诊误治。方法回顾性分析南昌大学第一附属医院骨科2014年4月—2015年5月收治的误诊为脊柱结核的非特异性脊柱感染8例临床资料。结果 8例首发症状均为脊柱病变区域局部疼痛,3例伴低热,1例有脊柱外伤史。病程初期均误诊为脊柱结核,误诊时间2周~3个月。8例入我院后经术后病理和病原学检查确诊,其中金黄色葡萄球菌感染2例,大肠埃希菌、革兰阴性菌感染各1例,无菌生长4例。8例确诊后均给予敏感抗生素抗感染治疗,5例行病灶清除术,随访3~12个月,病情均有不同程度改善。结论非特异性脊柱感染与脊柱结核均可表现为病变区域疼痛,临床及影像学表现无特异性,易相互误诊,病理和病原学诊断可资鉴别。     

以膝关节受累为主要表现的脊柱关节病15例误诊分析

脊柱关节病（SpA）是指以中轴关节和外周关节受累、具有家族聚集倾向、血清类风湿因子（RF）阴性以及与HLAB27呈不同程度相关性为特点的一组疾病,一般以炎症性腰痛为主要临床表现,诊断相对较易。我院2003～2004年收治以膝关节受累为主要临床表现的脊柱关节病15例,均误诊,现总结如下。     

大肠憩室62例临床并发症及误诊分析

目的;探讨大肠憩室住院患者的发病情况、临床特点及并发症。方法：对62例大肠憩室资料进行回顾性分析。结果：62例中老年人约占56％、40岁以下患者占10％;以乙状结肠、横结肠和升结肠检出率较高,左半结肠和右半结肠的检出率大致相同;约56％患者为症状性憩室,其中单纯憩室炎发生率约占并发症的57％,且以非老年人多见;而憩室出血和穿孔的发生率分别为23％和20％,以老年组高发。结论：大肠憩室以老年患者的患病率高,出血和穿孔等严重并发症以老年为主,单纯憩室炎等轻型并发症则以非老年多见,临床误诊率高。     

类风湿性关节炎和血清阴性脊柱关节病患者血清急性时相反应蛋白的测定及其临床意义

目的：观察活动期类风湿性关节炎（RA）和血清阴性脊柱关节病患者血清4种急性时相反应蛋白α1－酸性糖蛋白（AAG）、α1－扶胰蛋白酶（AAT）、触珠蛋白（HPT）和铜蓝蛋白（CER）浓度的变化及其临床意义。方法采用ARRAY360蛋白质测定系统测定61例RA和血清阴性脊柱关节病患者及31例正常对照组血清AAG、AAT、HPT、CER浓度并进行比较,结果RA、血清阴性脊柱关节病及差了炎综合组患者该4项指标浓度均显著高于正常对照组（P＜0．001）,并与血沉、C－反应蛋白呈正相关。结论动态观察血清4种急性时相反应蛋白浓度的变化对照于关节炎患者病变活动的监测以及及药物疗效的判断等有一定的临床指导意义。     

Dialysis-related spondyloarthropathy

OBJECTIVE: To discuss a case of dialysis-related spondyloarthropathy due to beta-2 microglobulin amyloid deposition. An emphasis is placed on the imaging findings. CLINICAL FEATURES: A 67-year-old man sought treatment for low back pain. His history revealed coronary artery bypass surgery, diabetes with bilateral foot neuropathy, gout, and bilateral renal failure that had been treated with dialysis for 2 years before left renal transplantation; the renal transplant had been performed 6 years earlier. Radiography, computed tomography, and magnetic resonance imaging revealed changes characteristic of dialysis-related spondyloarthropathy. INTERVETION AND OUTCOME: The patient was initially treated with physiotherapy. He was then admitted to the hospital and treated for renal infection and medicated for low back pain. Two weeks later he returned to the chiropractor, who began a treatment plan that included spinal manipulation, physiotherapy, manual distractive traction, and a gradual increase in activities of daily living. The patient was released from care after 2 months with significantly decreased pain. CONCLUSIONS: Dialysis-related spondyloarthropathy is a relatively uncommon complication of renal dialysis. It should be suspected in those patients who present with a correlative medical history and characteristic radiographic appearance. Chiropractic treatment can be effective as an adjunct to medical care in cases of chronic renal failure and associated complications.     

超声诊断胆管癌的误诊分析及改进方法探讨

目的探讨造成肝外胆管癌超声诊断的误诊的具体因素。方法对超声误诊的32例肝外胆管癌的误诊因素进行回顾性分析,并与其它影像学检查对照。结果共有4例假阳性和28例假阴性病例,以下段及上段胆管癌误诊率较高。团块型及狭窄型易误诊为肝内胆管结石、胰头或壶腹部癌、胆管炎症;2例误诊为肝癌;部分因肥胖和胃肠道气体干扰而误诊。结论胆管癌的超声误诊的具体因素较多,通过结合病史、临床症状,禁食饮水排除气体干扰,多切面观察,结合其它影像学检查可降低胆管癌的误诊率。     

Evolution of seronegative arthritis

The paper is concerned with the results of a follow up of 67 patients with seronegative arthritis. The average duration of observation was 7.6 yrs. Diagnoses in 4 patients were established on a repeated clinicolaboratory and x-ray study: ankylosing spondylitis, Reiter's syndrome, Yersinia arthritis and gonorrheal arthritis. A picture of seropositive rheumatoid arthritis was noted in 16 patients (24%). In 47 patients arthritis remained seronegative. Of them in 30 patients a course of disease did not differ from that of seropositive rheumatoid arthritis. Considerable progression of disease was noted at the acute onset of disease with multiple involvement of the joints and a high inflammatory and immunological activity of a process. A morphological investigation of the synovial bioptates in 20 patients did not reveal a classical picture of rheumatoid synovitis even in a prolonged course of seronegative rheumatoid arthritis. The authors defined two variants of morphological changes in the synovial tissue in this group corresponding to a benign and progressive course of seronegative RA.     

双原发癌五例漏误诊原因分析

双原发癌是多原发癌的一种,临床少见,由于人们对其认识不足,易漏诊或误诊。本文报告５例,并将误漏诊原因作一分析。１　临床资料１．１　一般资料　本组５例均为男性;年龄３８～７７岁,平均５８．２岁。有家族史者１例。５例中胃癌和结肠癌２例,结肠癌和直肠癌１例,喉癌和食管癌１例,肺癌和胃癌１例。１．２　临床表现及治疗　本组同时性双原发癌４例,第２原发癌均漏诊,其中２例术前分别只诊断为胃癌和直肠癌,术中探查却在结肠和胃分别发现第２原发恶性肿瘤;１例因腹部肿块、血便诊断为结肠癌,行右半结肠切除术,病理诊断为结…     

Laser therapy of seronegative spondyloarthritis

Multimodality therapy of 29 patients with Bekhterev's disease and Reiter's disease was performed. Of them 19 received external helium-neon laser therapy of the vertebral column and joints. A course of laser therapy consisted of 20-25 sessions. Therapeutic efficacy in this group of patients was assessed on the basis of clinicolaboratory indices and compared to the therapeutic results in the control group. A certain therapeutic effect of the use of laser therapy was obtained in patients with Bekhterev's disease and Reiter's disease proving the appropriateness and promise of further investigations in this direction.     

缓解性血清阴性对称性滑膜炎伴凹陷性水肿综合征与血清阴性类风湿性关节炎患者临床和实验室特征比较

目的 探讨缓解性血清阴性对称性滑膜炎伴凹陷性水肿(remitting seronegative symmetrical synovitis with pitting edema,RS3PE)综合征和血清阴性类风湿性关节炎(seronegative rheumatoid arthritis,SNRA)区别.方法 收集20...