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1、屮華結核和呼吸感染作者：林羽吳啟秋單位：101149北京,關鍵詞：結核,【摘要】目的孤立性脊柱椎弓結核的臨床特點及診斷治療1998年第10期第21卷論著徐雙錚管波清北京市結核病胸部腫瘤研究所件科骨關節(jié)；椎弓；診斷；外科，手術探討脊柱椎弓結核的臨床特點及診斷與治療。方法對1956?1996年收治的3825例脊椎結核中的17例椎弓結核的臨床表現及治療進行冋顧性分析。結果17例椎弓結核屮除1例為2歲兒童外，余均為青壯年，早期癥狀不典型，僅有局部固定性疼痛和壓痛，以后有膿腫痿管和神經系統癥狀出現。均經病史、體征、影像學檢查及細菌學檢杳綜合診斷，其
2、中僅1例誤診。17例中1例行抗結核藥物化療，16例在抗結核勿物化療下行椎弓病灶清除術，其中4例伴有神經系統癥狀者同期作了椎板切除減壓治療。結杲全部治愈,經隨訪無1例復發(fā)。結論椎弓結核早期癥狀較隱匿不易診斷，但限局性疼痛及X線、CT、磁共振(MRI)等檢查對該癥的早期診斷極有幫助，膿腫穿刺、抗酸染色涂片檢查常能明確診斷。手術是椎弓結核治療的重要手段。Clinicalfeatures,diagnosisandtreatmentofsolitaryvertebralarchtuberculosisLinYu,WuQiqiu,XuShuangzh
3、eng,etal.BeijingTuberculosisandThoracicTumourInstitute,Beijing101149[Abstract】ObjectiveToexploreclinicalfeaturesofvertebralarchtuberculosis,andtodiscussthediagnosisandtreatmentofthisillness.MethodSeventeenof3825casesofspinaltuberculosiswhowerehospitalizedandtreatedfrom195
4、6to1996werereviewed,andtheirclinicalfeatures,diagnosisandtreatmentwereanalysedandreported.ResultSixteencasesofvertebralarchtuberculosiswereinadolescenceandprimeoflife,andanotheronewasa2-year-oldchild?Theirsymptomsinearlystageswereuntypical,includinglocalfixedpainandtender
5、ness,andlater,abscess,fistulaandsymptomsofnervesystemappeared?Allthecaseswerediagnosedthroughsummarizingoftheirhistory,signs,imagingexaminationandbacteriologytests,andonlyonecasewasmisdiagnosed?Inoneof17cases,antituberculosischemotherapywasconductedaloneandnon-operationwa
6、sperformed.Intheother16cases,focaldebridementofvertebralarchwasperfonnedonthebasisofantituberculouschemotherapy,andin4casesofthemwithsymptomsofnervesystem,laminectomyandspinaldecompressionwasperformedhomochronously.Allthecaseswerehealedandnorelapseoccuredduringfollow-up.C
7、onclusionItisdifficulttodiagnosevertebralarchtuberculosisinearlystagesduetoitsoccultsymptoms,butthesymptomofconfinedpainandmanifestationinX-ray,CTandMRIaremuchusefulforearlydiagnosis.Abscesspunctureandacid-faststainingsmearmicroscopycanusuallybeusedtoconfirmdiagnosis.Ands
8、urgicalinterventionisanimportantmeasureforitstreatment?[Keywords]Tuberculosis,osteoailicularVert
