孤立性脊柱椎弓结核的临床特点及诊断治疗

目的探讨脊柱椎弓结核的临床特点及诊断与治疗。方法对１９５６～１９９６年收治的３８２５例脊椎结核中的１７例椎弓结核的临床表现及治疗进行回顾性分析。结果１７例椎弓结核中除１例为２岁儿童外，余均为青壮年，早期症状不典型，仅有局部固定性疼痛和压痛，以后有脓肿瘘管和神经系统症状出现。均经病史、体征、影像学检查及细菌学检查综合诊断，其中仅１例误诊。１７例中１例行抗结核药物化疗，１６例在抗结核药物化疗下行椎弓病灶清除术，其中４例伴有神经系统症状者同期作了椎板切除减压治疗。结果全部治愈，经随访无１例复发。结论椎弓结核早期症状较隐匿不易诊断，但限局性疼痛及Ｘ线、ＣＴ、磁共振（ＭＲＩ）等检查对该症的早期诊断极有帮助，脓肿穿刺、抗酸染色涂片检查常能明确诊断。手术是椎弓结核治疗的重要手段

Clinical features, diagnosis and treatment of solitary vertebral arch tuberculosis

Objective To explore clinical features of vertebral arch tuberculosis, and to discuss the diagnosis and treatment of this illness. Method Seventeen of 3 825 cases of spinal tuberculosis who were hospitalized and treated from 1956 to 1996 were reviewed, and their clinical features, diagnosis and treatment were analysed and reported. Result Sixteen cases of vertebral arch tuberculosis were in adolescence and prime of life, and another one was a 2 year old child. Their symptoms in early stages were untypical, including local fixed pain and tenderness, and later, abscess, fistula and symptoms of nerve system appeared. All the cases were diagnosed through summarizing of their history, signs, imaging examination and bacteriology tests, and only one case was misdiagnosed. In one of 17 cases, antituberculosis chemotherapy was conducted alone and non operation was performed. In the other 16 cases, focal debridement of vertebral arch was performed on the basis of antituberculous chemotherapy, and in 4 cases of them with symptoms of nerve system, laminectomy and spinal decompression was performed homochronously. All the cases were healed and no relapse occured during follow up. Conclusion It is difficult to diagnose vertebral arch tuberculosis in early stages due to its occult symptoms, but the symptom of confined pain and manifestation in X ray, CT and MRI are much useful for early diagnosis. Abscess puncture and acid fast staining smear microscopy can usually be used to confirm diagnosis. And surgical intervention is an important measure for its treatment.