脊椎結核症病例報告

Diagnosis and Management of Spinal Tuberculosis: A Report of Three Cases

黃乃炯(Nai-Chung Huang) ； 魏大森(Ta-Sen Wei) ； 陳威志(Uei-Jyh Chen)

《中華民國復健醫學會雜誌》 22卷1期 (1994/06) Pp. 91-96

摘要

結核症主要侵犯肺部，骨骼關節的感染比率較低，但因後者大半發生在脊椎，病人可能因為背痛來到復健部門求診，因此脊椎結核症是背痛疾患中不可忽視的原因。本文報告三個脊椎結核症病例，病人共同特點是對於一般止痛藥物及物理治療效果不佳，而且疼痛的位置在胸腰椎交界中線附近，屬不常見之背痛部位，同時伴有局部的敲擊痛。經磁振掃描檢查三例均有椎體旁膿瘍現象。兩名年紀較大的男性病例因伴有神經學症狀〈下肢無力、麻木等〉，除接受抗結核藥物治療外，也接受手術治療。其中一名於發病半個月內接受手術，病人經復健治療後目前已可行走自如。另一名較晚確定診斷，且伴有腰椎退化性關節炎，雖經同樣治療，至今仍臥床接受保守性復健。第三例為一44歲女性，病人未伴隨明顯神經學症狀而且拒絕開刀，因此僅給抗結核藥物治療，疼痛明顯改善，目前患者日常活動功能恢復正常。
結論：1.病患因背痛來求診時，若復健及藥物治療無效，且背痛位置不尋常，甚至伴有敲擊痛的現象時，除腫瘤外，脊椎結核症亦要列入考慮。2.核磁共振掃描對於脊椎結核症的診斷，以及神經併發症的預測有很大的帑助。3.脊椎結核症若能早期診斷早期治療，患者大多可獲得不錯的預後。

關鍵字

脊椎結核症 ； 核磁共振掃描

並列摘要

The majority of tuberculosis bacillus infection is in the lung. Although the incidence of infection in the skeletal system is low, spinal tuberculosis is on important cause of hack pain in the Rehabilitation Outpatient Department because it is the most skeletal site affected.
During the past year, we managed three cases of spinal tuberculosis. The characteristics of these patients were 1) backache over the thoracolum-bar junction with knocking pain, 2) fair response to analgesics and physical modalities and Paras-pinal abscess noted on MRI (Magnetic Resonance Image) examination. Chemotherapy and surgery were performed in two cases with significant neurological symptoms (weakness and numbness of lower extremities). Case 1 was a 74 year-old male patient with lesion site over the tenth thoracic spine. Spinal tuberculosis was suspected after MRI examination. Surgical intervention was performed Wthin 2 weeks and spinal tuberculosis was proved by histological examination. The patient could ambulate independently after rehabilitation program. Case 2 was a 70 yearold male with a lesion located at the second and third lumbar spine- The diagnosis of spinal tuberculosis was made three months after onset of backache owing to doctor shopping. Severe lumbar spondylosis was noted in this patient. The patient is bedridden at present in spite of rehabilitation therapy. Another case was a 44 year-old female whose lesion was located at the second and third lumbar spine. Two months after the onset of backache, MRI was arranged. It revealed a destroyed and narrowed intervertebral disc space between the second and third lumbar spine with a perivertebral soft tissue mass. No significant neurological signs were noted. The patient refused surgical intervention, so only chemotherapy was given. Backache improved and daily living activities were near normal after therapy.
In summary: 1) Tumor and tuberculosis should be taken into consideration in the backache patients with uncommon locations accompanyed by knocking pain and poor response to analgesics and physical therapy. 2) MRI is of great help in both the diagnosis of spinal tuberculosis and prediction of neurologic complications. 3) The earlier diagnosis and treatment are performed, the better prognosis of the patient.

並列關鍵字

TB spine ； Pott's disease ； Magnetic Resonance Imaging