摘要
目的探讨脊柱结核早期的临床表现和影像学特点。方法对19例脊柱结核患者行X线、CT和MRI检查,同时行PPD试验、血沉、胸片、胸部CT和ECT等检查。明确诊断后再进行正规抗结核治疗。结果脊柱结核早期患者全身结核毒性症状并不典型,患者均表现为不同程度的局部疼痛,其中8例患者曾被误诊。CT检查能清晰地显示椎体内较小的溶骨性、虫蚀状改变等骨质破坏灶及其内毛玻璃状高密度的死骨(19例),周围可伴有骨增生硬化带(10例),可伴有椎前软组织肿胀。MRI发现椎体骨炎(19例)及终板破坏,以及骨内小脓肿。早期椎间盘信号正常或高信号为主、椎间隙正常。结论脊柱结核早期患者常表现为局部疼痛,可不伴有典型的结核中毒症状。CT能显示早期微小的脊柱结核病变如骨质破坏、死骨等现象;MRI能清楚显示椎体骨炎、终板和(或)椎间盘的破坏和椎体内小灶骨脓肿。结合CT和MRI两者优点,可较早诊断脊柱结核;从而指导临床尽早进行抗结核治疗,避免漏诊、延迟诊断或误诊带来的不良后果,具有较大临床意义。
Objective To study the features of the clinical presentation and radiology of the spinal tuberculosis at the early phase. Methods All patients underwent X ray, CT and MRI examinations, meanwhile, they underwent PPD test, blood sedimentation, chest X-ray, chest CT and MRI scannings. All cases accepted regular antitubereulotic treatment after clear-cut diagnosis. Results The patients suffered with the spinal tuberculosis at the early stage were atypical of tubereulotic toxic symptoms. Many of them demonstrated with local pain and tended to be missed diagnosis and delayed diagnosis. The CT examination could easily find the radiological presentation including the small osteolytic or worm-eaten destruction within the sequester in it. The vertebral osteitis, the end-plate destruction and the small lesion of bone abscess in the vertebral body could be found by the MRI. Conclusions The typical presentation of the spinal tuberculosis could not be found in the patients with spinal tuberculosis at the early stage. There is no typical X ray findings in these cases. The early vertebral changes such as the small osteolytic or worm-eaten destruction within the sequester could be found in the CT. The vertebral osteitis, the end-plate destruction and the small lesion of bone abscess in the vertebral body could be found by the MRI, which might be useful in the decision of early antituberculotic treatment and therefore, could be of great clinical significance.
出处
《临床骨科杂志》
2007年第1期16-19,共4页
Journal of Clinical Orthopaedics
关键词
结核
脊柱/诊断
结核
脊柱/药物疗法
tuberculosis, spinal/diagnosis
tuberculosis, spinal/drug therapy
