摘要
目的探讨颈椎结核的早期识别方法,以减少误诊。方法回顾分析1例颈椎结核的误诊误治经过,并复习相关文献。结果患者因颈部疼痛伴发热1月余,颈部疼痛加重影响睡眠来我院急诊。病程中先后在多家医院就诊,先后误诊为颈椎病、陈旧性肺结核、脑卒中和颈脊髓炎。入我院后经检查排除上述诊断,查血红细胞沉降率21 mm/h,结核感染T细胞检测阳性;颈椎CT检查示第6颈椎椎体下缘骨质不连续、椎间隙变窄。确诊为颈椎结核,转专科医院予规范抗结核治疗,病情缓解。结论对于颈部疼痛伴双肩麻木患者,诊断除考虑外伤、颈椎病、脑卒中等颈部结构和血管性疾病外,还应警惕颈椎结核的可能。
Objective To investigate the early method of differential diagnosis of tuberculous cervical spondylitis in order to avoid misdiagnosis. Methods Process of misdiagnosis and mistreatment of a patient with tuberculous cervical spon- dylitis was retrospectively analyzed, and related literature was reviewed. Results The patient had neck pain associated by fe- ver for more than 1 month, and aggratated pain affected sleep, and then the patient visited a doctor. The patient had been mis- diagnosed as having cervical spondylosis, old pulmonary tuberculosis, cerebral apoplexy and neck myelitis successively. After ruling out the above-mentioned diagnosis, the erythrocyte sedimentation rate was 21 mm/h, and tuberculosis T cell detection was positive. CT scanning of cervical vertebra showed that inferior edge of the 6th cervical vertebra was discontinuous selerotin and narrowing intervertebra] space. The final diagnosis was tuberculous cervical spondylitis. The patient＇s condition was relieved after standard antitubereulous therapy by special hospitals. Conclusion The diagnosis for patients with neck pain asso- ciated by shoulders numbness should be considered neck structure and vascular diseases such as trauma, cervical spondylosis and cerebral apoplexy in addition to tuberculous cervical spondylitis.
作者
王魏魏
姜婷
李春雨
陈君
何其芳
张恒东
张劲松
白莹
朱宝立
陈彦
WANG Wei-wei JIANG Ting LI Chun-yu CHEN Jun HE Qi-fang ZHANG Heng-dong ZHANG Jin-song BAI Ying ZHU Bao-li CHEN Yan(Emergency Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210028, China)
出处
《临床误诊误治》
2017年第1期7-9,共3页
Clinical Misdiagnosis & Mistherapy
基金
江苏省"六大人才高峰"第十批高层次人才项目(2013WSN035)
关键词
结核
脊柱
颈椎病
误诊
卒中
脊髓炎
Tuberculosis
Spine
Cervical spondylosis
Misdiagnosis
Stroke
Myelitis
