脊柱结核74例诊断分析

[目的]分析脊柱结核的临床特点及影像学表现,提高对本病的诊断水平。[方法]回顾性分析2004年4月～2009年2月收治、经病理检查证实为脊柱结核的74例患者临床资料,总结临床特点及影像学表现在本病诊断中的价值。[结果]根据患者的临床症状及体征在首诊时即考虑脊柱结核并经影像学、病理学检查证实者28例,占37.8%。行X线片检查后诊断为脊柱结核者51例,占68.9%,行CT及MRI检查后诊断为脊柱结核者73例,占98.6%。临床、影像资料齐全,术前仍误诊为脊柱转移瘤1例,占1.4%。[结论]早期的脊柱结核或不典型脊柱结核很难根据临床表现在首诊时即诊断为脊柱结核,影像学检查是该病的主要诊断方法,CT及MRI对于脊柱结核的确诊具有重要价值。极少数诊断困难的病例,可以作介入穿刺检查或者行术中冰冻切片病理检查。     

骶髂关节结核的误诊及早期诊断

目的探讨骶髂关节结核误诊原因及提高其早期诊断措施。方法回顾性分析17例骶髂关节结核临床表现、体征及影像学特征，了解误诊情况。结果本组病例早期误诊率较高，17例中16例曾误诊为其他疾病。结论骶髂关节结核进展缓慢，早期症状及影像学表现不典型，且与骶髂关节其他疾病相类似是误诊的主要原因。掌握其发病特征，结合骶髂关节被动运动性疼痛试验检查，早期骶髂关节正位片及CT检查是提高其早期诊断的主要措施。     

脊柱骨髓炎误诊为脊柱结核7例临床病理分析

脊柱化脓性骨髓炎起病隐匿,临床症状及影像学改变往往需要数周到数月,早期诊断比较困难,不典型者容易与缺乏典型临床表现及影像学特征的脊柱结核相混淆而造成误诊。现对我院自2004年9月至2008年12月共7例脊柱化脓性骨髓炎误诊脊柱结核病例进行回顾性分析,以期提高诊断正确率。     

不典型脊柱结核的临床特点分析

[目的]探讨脊柱结核的一些临床特征,分析其原因,提高对脊柱结核的早期诊断水平.[方法]对本院2006年10月～2010年9月收治的39例脊柱结核患者的临床资料作回顾性研究.[结果]39例脊柱结核患者具有不典型的临床特点:结核菌素全身中毒症状表现不明显;体征以腰腿痛为主,少有后凸畸形;影像学表现在早期常不典型;实验室检查无敏感性、特异性.[结论]脊柱结核患者的临床特点常不典型,应完善实验室和影像学检查,注意随访,提高早期诊断的成功率.     

误诊为结核的非典型脊柱化脓性感染

脊柱的化脓性感染临床上较少见，后果非常严重，须尽快明确诊断和治疗。不典型患者不易与缺乏典型临床表现及及影像学特征的脊柱结核相鉴别，容易造成误诊。本院自1999—2006年间一共收治该类患者8例，均误诊为脊柱结核，将有关资料总结如下。     

脊柱结核再次手术原因分析

目的：总结分析脊柱结核再次手术的原因。方法：对1995年9月～2006年12月手术治疗的313例脊柱结核患者的临床资料进行回顾性分析，统计其中再次手术病例，分组分析其再次手术的原因，并对因结核复发或迁延不愈再次手术者的相关因素行统计学分析。结果：再次手术者中因结核复发或迁延不愈者38例，因第一次手术误诊者2例，因术后发生脊柱后凸畸形者5例，因术后发生椎管狭窄者2例。统计分析表明，术前患肺或胸膜结核、术前用药时间〈4周及胸腰段（T10-L2）脊柱结核患者复发或迁延不愈发生率较高（P〈0．05）；而不同性别、不同年龄及是否应用内固定间的结核复发或迁延不愈发生率无显著性差异（P〉0．05）。结论：引起脊柱结核再次手术原因包括术后脊柱结核复发或迁延不愈、误诊、术后椎管狭窄及脊柱后凸畸形等，术前是否患有肺或胸膜结核、术前用药时间及病变部位与结核复发或迁延不愈有相关性。     

脊柱结核诊治不当的原因分析

目的：总结脊柱结核诊治不当原因。方法：回顾分析10年来本院收治的125例脊柱结核患者的诊断与治疗资料,并对其诊治不当的原因进行分析。结果：延误和误诊7例（占5．6％）,规范抗痨治疗85例中结核复发3例（3．52％）;不规范抗疲劳治疗40例中结核复发5例（12．5％）。手术方法不当5例,占手术例数13．1％（5／38）,术后护理不当2例,占5．2％（2／38）。结论：脊柱结核容易引起误诊误治,手术及护理方法不当会影响治疗效果,应提高认识,及早诊治、加强规范的抗痨治疗方法,选择正确的手术方式,加强术后护理。     

非典型性脊柱结核

在全球范围内,结核病包括骨关节结核呈上升趋势,已受到世界各国政府和社会的广泛关注。临床上多数脊柱在全球范围内,结核病包括骨关节结核呈上升趋势,已受到世界各国政府和社会的广泛关注。临床上多数脊柱结核的诊断一般不困难,患者有结核中毒症状,出现邻近椎体和椎间盘的破坏,使椎体塌陷,形成后凸畸形,并出现椎旁脓肿,脊髓压迫等。但也有相当一部分脊柱结核不具备这些典型的临床表现和影像学特征,这类脊柱结核统称为非典型性脊柱结核(atypicalspinaltuberculosis),诊断较为困难,易出现误诊和误治,因此需引起足够的重视。1非典型性脊柱结核…     

肺结核并胸腰椎及骶髂结核误诊为肺癌骨转移1例报告

不典型肺结核合并不典型脊柱结核临床较为少见,有时容易与肺癌骨转移相混淆,诊断较为困难,本院收治1例肺结核并胸腰椎及骶髂结核患者,患者无明显结核中毒症状,实验室及影像学检查基本不支持结核的诊断,术后病灶病理学检查符合结核。诊疗过程报道如下。     

睾丸结核11例临床分析

目的：分析睾丸结核误诊误治的相关因素,探讨临床睾丸结核诊断及治疗方法。方法：回顾性分析2008～2011年收治11例睾丸结核患者的临床资料。结果：睾丸结核患者病史3～18个月。11例睾丸结核中合并附睾结核10例,合并肺结核6例。5例曾被误诊为附睾睾丸炎。误诊主要原因是早期临床表现不典型,缺乏影像学检查。11例中,7例通过术后病理检查结果确诊,4例经睾丸穿刺活检确诊。误诊时间平均4个月。3例经6个月抗结核治疗后痊愈,8例经抗结核及手术治疗后痊愈,随访6个月未见复发。结论：睾丸结核临床少见,漏误诊率较高。B超、CT、MRI和睾丸穿刺细胞学检查有助于睾丸结核诊断。对于局部于酪样坏死严重,病变较大且有脓肿形成或抗结核治疗效果不明显的患者可以考虑手术治疗。     

Atypical intradural spinal tuberculosis: report of three cases

OBJECTIVE: To report three cases of intradural spinal tuberculosis (TB) by calling attention to atypical forms of spinal TB. SETTING: A University Hospital, Istanbul, Turkey. METHODS: Histopathological, radiological, surgical and physical examination findings of three patients with spinal TB were retrospectively reviewed. RESULTS: Based on histopathological, surgical and radiological findings, diagnosis of intramedullary abscess had been made in the first case and early and late phases of arachnoiditis in the other two patients, respectively.The clinical outcome was evaluated as satisfactory for the patient with intramedullary abscess who had been treated with medical and surgical interventions. The remaining two patients with arachnoiditis, who had been treated by shunting or simple decompression, had a relatively less favorable clinical outcome. CONCLUSION: Spinal TB, in its atypical forms, is a rare clinical entity and low index of suspicion on the part of the surgeon may result in misdiagnosis such as neoplasm. In cases presenting with an intraspinal mass lesion, possibility of a tuberculous abscess and/or a granuloma should be considered in the differential diagnosis.     

脊柱结核早期诊断的研究进展

探讨脊柱结核特点。脊柱结核如果能在早期发现,对于治疗和预后意义重大。目前脊柱结核的早期诊断已经成为研究热点,诊断方法种类繁多。最新提出免疫与结核诊断密切相关,将成为脊柱结核今后研究的焦点,也是未来检测的发展方向。另外,还需熟悉脊柱结核的鉴别诊断,以免误诊为其他脊柱疾病。     

不典型脊柱结核的临床特点与诊疗体会

目的 探讨不典型脊柱结核的临床特点与诊断方法。方法 回顾性分析18例不典型脊柱结核的临床表现和辅助检查资料,15例均行前路病灶清除及植骨融合术,3例行后路椎管探查、减压、椎间盘髓核摘除术后迁延不愈,再次经前路彻底切除椎间盘、终板和病变骨质,并行椎弓根内固定及椎板植骨。结果 18例患者术后均获随访,时间12-28个月,疼痛症状均明显缓解或消失,神经功能也明显恢复。不全瘫痪的11例Frankel分级：术前A级的1例恢复为E级;术前B级者,1例恢复至D级、1例恢复至E级;术前C级者,2例恢复至D级、1例恢复至E级;术前D级的5例均恢复至E级。X线复查片示骨结核病灶已痊愈,植骨融合良好。结论 对有伴随症状的椎体破坏,应将脊柱结核作为主要的鉴别诊断,不能片面强调或突出某一方面征象。在病检未确诊以前,术前术后都应坚持抗结核治疗。     

Submuscular gluteal abcess: An unusual presentation of rare sacral tuberculosis

IntroductionBoth gluteal abscess and sacral tuberculosis are rare entities in spinal tuberculosis cases. Even in endemic country, this atypical presentation may be the cause of delayed diagnosis and treatment.Presentation of caseA 51-year-old woman was admitted with painless massive lump on both of her thighs that have been enlarging for the past 6 months. She had a history of previous tuberculosis treatment. From the MRI examination submuscular gluteal abscess, which was an extension of the sacral tuberculosis, were found. Open debridement and biopsy were performed, which confirmed the suspicion of tuberculosis. Oral anti tuberculosis drugs were administered after. There was no recurrence and complication at the final follow up.DiscussionCold abscess formation is common in spine tuberculosis however the formation of gluteal abscess as the extension of sacral tuberculosis is rare. Although MRI's specificity in determining the underlying cause is poor, it has a great role not only determining the location and size of the lesion, but also to describe anatomical pathophysiology of the abscess dissemination from sacral tuberculosis.ConclusionDespite the limitation of the study and the rarity of this case, tuberculosis should be made as the main differential diagnosis for atypical sacral lesion that occurs with submuscular gluteal abscess.     

脊柱结核的早期诊断和治疗

目的探讨脊柱结核早期的临床表现和影像学特点。方法对19例脊柱结核患者行X线、CT和MRI检查，同时行PPD试验、血沉、胸片、胸部CT和ECT等检查。明确诊断后再进行正规抗结核治疗。结果脊柱结核早期患者全身结核毒性症状并不典型，患者均表现为不同程度的局部疼痛，其中8例患者曾被误诊。CT检查能清晰地显示椎体内较小的溶骨性、虫蚀状改变等骨质破坏灶及其内毛玻璃状高密度的死骨（19例），周围可伴有骨增生硬化带（10例），可伴有椎前软组织肿胀。MRI发现椎体骨炎（19例）及终板破坏，以及骨内小脓肿。早期椎间盘信号正常或高信号为主、椎间隙正常。结论脊柱结核早期患者常表现为局部疼痛，可不伴有典型的结核中毒症状。CT能显示早期微小的脊柱结核病变如骨质破坏、死骨等现象；MRI能清楚显示椎体骨炎、终板和（或）椎间盘的破坏和椎体内小灶骨脓肿。结合CT和MRI两者优点，可较早诊断脊柱结核；从而指导临床尽早进行抗结核治疗，避免漏诊、延迟诊断或误诊带来的不良后果，具有较大临床意义。     

Imaging presentation highly manifested as tuberculosis in a case of spinal metastatic carcinoma

Usually the clinical manifestations between spinal tuberculosis (Pott's disease) and metastasis are not characteristic. Nevertheless, their respective imaging presentations are typical and specific, which makes it relatively easier to attain a correct diagnosis. Imaging features of Pott's disease, in general, include narrowing of intervertebral disk space, collapse of vertebral bodies with eventual progression to kyphotic deformity, destruction of the anterior parts of adjacent vertebrae, formation of a large paravertebral abscess, and calcifications or sequestra within the paravertebral abscess. Spinal tuberculosis is usually endemic, especially in Eastern countries. However, the trend of cancer incidence is also increasing in modern society, which makes it difficult to diagnose spinal osseous lesions. This article presents a case of a 45-year-old man with a 9-month history of low back pain. Both computed tomography and magnetic resonance imaging of the lumbar spine supported the initial diagnosis of spinal tuberculosis. However, pathological examination on the excised specimen resulted in the diagnosis of spinal metastatic adenocarcinoma. We suggest that a definitive diagnosis of spinal metastasis or tuberculosis should not be based on imaging alone. Instead, more attention should be paid to atypical imaging presentations. In addition, biopsy is usually necessary for final diagnosis.     

Unusual presentation of isolated sacral tuberculosis

Tuberculosis is as old as mankind. Vertebral tuberculosis is fairly common form of bone and joint tuberculosis. However, isolated sacral tuberculosis is rare. It may present as an atypical sacral lesion having epidural granuloma without destruction of sacrum on MRI and plain X-rays. This atypical presentation may lead to delay in diagnosis and treatment. This case report intends to emphasize that spinal tuberculosis should be the first and foremost differential diagnosis in the presence of atypical clinical and radiological features of a sacral lesion particularly in developing countries. Early diagnosis and treatment can prevent or minimize the neurological morbidity in such cases.     

Atypical spinal tuberculosis

Typical spinal tuberculosis is readily diagnosed and treated. Certain atypical clinical and radiologic presentations of spinal tuberculosis are described. Failure to recognize these presentations may lead to delay in diagnosis and initiation of treatment. In some atypical forms of the disease, this may have disastrous consequences. The current authors present a new classification for atypical spinal tuberculosis and describe the various presentations. The role of advanced imaging studies such as computed tomography scanning and magnetic resonance imaging and imaging-guided aspiration cytology is discussed.     

泌尿系结核16例误诊分析

目的 探讨泌尿系结核的误诊原因.方法 回顾性分析16例泌尿系结核在诊治过程中的误诊原因.16例均曾被误诊为慢性膀胱炎,其中诊断伴有肾积水、肾结石6例,多囊肾1例,附睾炎1例.结果 2例患者经手术治疗,术后病理证实肾结核.14例经药物治疗.通过尿沉渣涂片抗酸染色、PPD试验、B超、静脉尿路造影、CT及膀胱镜检查提示本病.11例患者随访6个月~4年,经手术及药物治疗后病情均未进展.结论 对存在有长期慢性膀胱炎病史的患者需进一步的病因检查,实验室检查及影像学检查具有重要的诊断价值,同时应提高对检查结果正确分析的能力.