跳跃性脊柱结核诊断与治疗研究进展

Research Progress in the Diagnosis and Treatment of Noncontiguous Spinal Tuberculosis

摘要: 结核病通常由来自原发病灶结核杆菌通过血行播散感染全身器官和组织，脊柱结核在脊柱感染性疾病中发病率仍比较高，特别是在发展中国家及医疗水平相对不发达地区更是如此，近年来脊柱结核大有卷土重来之势。目前在临床上多节段或跳跃性脊柱结核的患者仍比较多，但是由于其特点是存在被正常的椎体所隔开至少两处脊柱椎体或附件结核病灶，极易出现漏诊，随着近年来MRI普及，漏诊率有所下降。对于跳跃性脊柱结核，除了彻底的病史和体格检查外，应进行适当的实验室和影像学检查，或组织病理学评估，以作出准确的诊断。相对于普通单病灶脊柱结核，跳跃性脊柱结核症状更重，更易出现神经功能缺损，治疗难度也相对更大。本文主要对跳跃性脊柱结核诊断及治疗做一综述，以提高临床医生对该病的理解以及为临床治疗提供依据。

Abstract: Tuberculosis usually infects the organs and tissues of the whole body through blood line dissemina-tion by TB bacilli from the primary focus. The incidence rate of spinal tuberculosis in spinal infec-tious diseases is still relatively high, especially in developing countries and regions with relatively underdeveloped medical standards. In recent years, spinal tuberculosis has a great potential to make a comeback. At present, there are still more patients with multi segmental or noncontiguous spinal tuberculosis clinically, but because of its characteristic that there are at least two spinal ver-tebrae or accessory tuberculosis foci separated by normal vertebrae, it is very easy to miss diagno-sis. With the popularity of MRI in recent years, the rate of missed diagnosis has declined. For non-contiguous spinal tuberculosis, in addition to thorough medical history and physical examination, appropriate laboratory and imaging examinations, or histopathological assessments should be conducted to make an accurate diagnosis. Compared to ordinary single lesion spinal tuberculosis, noncontiguous spinal tuberculosis has more severe symptoms, is more prone to neurological defi-cits, and is relatively more difficult to treat. This article mainly provides a review of the diagnosis and treatment of noncontiguous spinal tuberculosis, in order to improve clinical doctors’ under-standing of the disease and provide a basis for clinical treatment.