最近の脊椎カリエスにおけるDoctor's delayの検討 Current trends in delayed diagnosis of tuberculous spine and associated factors

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Abstract

近年の脊椎カリエスのDoctor's delayの原因と傾向を調査するために,平成17年以降の4年間に当科で脊椎カリエスの治療を行った17例を検討した.Doctor's delay 群は7例あり,すべて結核の既往がなかった.また,他の疾患の診断のもと治療が行われていたものが多く,診断名は,骨粗鬆性圧迫骨折が4例,腰部脊柱管狭窄症が1例,腫瘍が1例,精巣上体炎が1例あった.これらの診断ですでに手術されていたものが5例あり,術前診断は圧迫骨折が4例,腰部脊柱管狭窄症が1例であった.Doctor's delay例では骨粗鬆性圧迫骨折の診断で手術が施行された症例が多かったが,術前の画像所見は典型的な骨粗鬆性圧迫骨折ではなかった.近年,圧迫骨折に対する手術が積極的に施行されるようになってきたが,術前に脊椎カリエスを鑑別することの重要性を再認識すべきである.

Current trends in delayed diagnosis of tuberculous (TB) spine and associated factors were retrospectively analyzed. A total of 17 subjects who were admitted to our hospital between 2005 and 2009 were included in this study. Diagnosis of TB was made by PCR in 8 patients (57%). Culture for acid-fast bacteria was negative in 3 patients 8 (37%).There were 7 patients in the delayed diagnosis group, defined as patients whose diagnosis of TB spine required more than 5 months. In this group, there was no past history of TB. Mantoux test was never attempted. Of these 7 patients, 5 had been surgically treated because of misdiagnosed etiologies. Although osteoporotic compression fracture was a common misdiagnosis (n=4), three patients showed abscess formation and/or disc lesion on retrospective review of the pre-surgical diagnostic imaging studies.

Journal

  • The Journal of Japanese Society of Lumbar Spine Disorders

    The Journal of Japanese Society of Lumbar Spine Disorders 15(1), 173-179, 2008

    The Japanese Society of Lumbar Spine Disorders

Codes

  • NII Article ID (NAID)
    130000152047
  • NII NACSIS-CAT ID (NCID)
    AA11488721
  • Text Lang
    UNK
  • ISSN
    1345-9074
  • NDL Article ID
    10487702
  • NDL Source Classification
    ZS35(科学技術--医学--外科学・整形外科学・麻酔学)
  • NDL Call No.
    Z19-B834
  • Data Source
    NDL  J-STAGE 
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