多家医院误诊的颈椎结核诊断反思并文献复习

摘要

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 6 th cervical vertebra was discontinuous sclerotin and narrowing intervertebral space. The final diagnosis was tuberculous cervical spondylitis. The patientˊs condition was re-lieved after standard antituberculous 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.%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。