非特异性脊柱感染误诊的临床分析

目的：针对误诊为脊柱结核的非特异性感染病例，探讨非结核性脊柱感染的特点，为提高其诊治水平提供临床数据。方法回顾性分析2009年5月～2012年7月收治的23例疑似脊柱结核病例的临床资料。13例患椎部位有明显疼痛；10例有轻度疼痛，活动后加重。影像学检查提示椎体破坏、椎间隙变窄，椎前软组织肿胀。均行病灶清除植骨融合内固定术，并行组织病理学检查、细菌学培养、菌种鉴定、药敏试验等实验室检查，术后应用敏感或广谱抗生素。结果本组随访10～24个月，平均15个月。结核分枝杆菌培养及PCR检测阴性，普通细菌培养阳性10例，其中金黄色葡萄球菌6例、大肠埃希菌2例、克雷伯白菌1例、真菌1例；细菌培养阴性13例。治疗后疼痛均明显好转，神经损害有所恢复。感染得到控制，无复发。结论脊柱非特异性感染的诊断应当结合临床症状，全面有针对性的细菌学检查以及影像学技术或辅以诊断性治疗才能降低其误诊率。

Clinical analysis of non-specific spinal infection

Objective The clinical characteristics of the patients of non-specific spinal infection misdiagnosed as spinal tuberculosis were analyzed in order to provide clinical data for improving the diagnosis and treatment of non-specific spinal infection. Methods Retrospective analysis on the clinical data of 23 non-specific spinal infection patients misdiagnosed as suspected spinal tuberculosis from May 2009 to July 2012 was carried out.Thirteen cases presented with significant pain,while 10 patients presented with mild pain and aggravated actively.Imaging studies suggest vertebral destruction, disc space narrowing, prevertebral soft tissue swelling.All the patients underwent focal cleaning and bone grafting and fusion combined with internal fixation.All patients received laboratory tests including histopathological examination,bacteriological culture, strain identification and drug sensitivity test.Postoperatively, patients were treated with sensitive or broad-spectrum antibiotics.Results The mean follow-up was 15 months(10-24 months).Mycobacterium tuberculosis culture and PCR assay was negative.Ordinary bacterial culture was positive in 10 cases and negative in 13 cases.The pathogens identified were staphylococcus aureus (6 cases),Escherichia coli (2 cases), klebsiella spp (1 case) and fungal(1 case).All patients were completely relieved of pain and had a neurological deficit improved.The infection was under control and all the patients were resolved without recurrence.Conclusion In order to reduce the misdiagnosed rate of non-specific spinal infection, clinical symptoms,comprehensively targeted bacteriological examination, imaging techniques or diagnostic treatment should be comprehensively analyzed to make diagnosis.