关键词：结核，骨关节；椎弓；诊断；外科，手术
【摘要】 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 LinYu, Wu Qiqiu, Xu Shuangzheng, et al. Beijing Tuberculosis and Thoracic Tumour Institute,Beijing 101149
【Abstract】 Objective To explore clinical features ofvertebral arch tuberculosis, and to discuss the diagnosis and treatment of this illness. Method Seventeenof 3 825 cases of spinal tuberculosis who were hospitalized and treated from 1956 to 1996were reviewed, and their clinical features, diagnosis and treatment were analysed andreported. Result Sixteen cases of vertebral arch tuberculosis were inadolescence and prime of life, and another one was a 2-year-old child. Their symptoms inearly stages were untypical, including local fixed pain and tenderness, and later,abscess, fistula and symptoms of nerve system appeared. All the cases were diagnosedthrough summarizing of their history, signs, imaging examination and bacteriology tests,and only one case was misdiagnosed. In one of 17 cases, antituberculosis chemotherapy wasconducted alone and non-operation was performed. In the other 16 cases, focal debridementof vertebral arch was performed on the basis of antituberculous chemotherapy, and in 4cases of them with symptoms of nerve system, laminectomy and spinal decompression wasperformed homochronously. All the cases were healed and no relapse occured duringfollow-up. Conclusion It is difficult to diagnose vertebral archtuberculosis in early stages due to its occult symptoms, but the symptom of confined painand manifestation in X-ray, CT and MRI are much useful for early diagnosis. Abscesspuncture and acid-fast staining smear microscopy can usually be used to confirm diagnosis.And surgical intervention is an important measure for its treatment.
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