目的:探讨成人单椎体孤立性结核的临床特点及治疗方法。方法:2005年2月～2009年10月我院收治成人脊柱结核患者286例,其中单椎体结核患者6例,男4例,女2例;年龄20～38岁,平均26.2岁。均以腰痛为首发症状。病变均在腰椎,L11例,L22例,L32例,L41例。6例均行脊柱X线平片、CT扫描及MRI检查,X线平片上均无阳性发现;腰椎常规CT扫描2例发现椎体下缘孤立性囊性病灶,4例为轻度椎间盘突出;MRI检查均显示单椎体内圆形病灶,T1低信号、T2高信号改变,邻近椎间盘、附件信号正常,病变椎体轮廓及高度无异常。对病变椎体行CT扫描,可见椎体内为孤立性囊性溶骨性病灶,椎旁软组织未受累。2例术前未确诊,行病灶探查清除植骨术;4例结合临床诊断为单椎体结核,经抗结核治疗2～3周后行椎体内病灶清除、髂骨填塞植骨术。术后均行抗结核药物治疗8～10个月。结果:术后病理检查证实椎体病变均为结核改变。患者均获随访,随访时间1～4年,平均2年3个月,半年内血沉均恢复正常,腰痛症状逐渐消失,X线片证实植骨均愈合,平均骨融合时间为3.8个月。随访期间结核无复发。结论:成人单椎体孤立性结核临床较为少见,临床症状及影像学表现均不典型,CT和MRI联合检查可明确病灶的范围及骨破坏类型,规范抗结核药物治疗结合病灶清除椎体内植骨可取得良好疗效。 Objective: To investigate the clinical features and treatment of single vertebra solitary tuberculosis in adults. Methods: From February 2005 to October 2009, 286 adult patients with spinal tuberculosis were admitted to our hospital, including 6 patients with single vertebral tuberculosis. There were 4 males and 2 females, aged from 20 to 38 years with an average of 26.2 years. Low back pain are the first symptom. Lesions were in the lumbar spine, L11 cases, L22 cases, L32 cases, L41 cases. Six cases underwent plain radiography, CT scan and MRI examination. No positive findings were found on plain radiographs. In 2 cases of lumbar vertebrae, a solitary cystic lesion on the lower edge of the vertebral body was found in 2 cases and mild disc herniation in 4 cases. MRI examination showed a single vertebral body circular lesions, T1 low signal, T2 high signal changes, adjacent disc, attachment signal is normal, vertebral body contour and height without exception. On the lesion vertebral CT scan, we can see the isolated vertebral osteolytic lesions, paravertebral soft tissue is not involved. 2 cases were not diagnosed preoperatively, and the lesions were removed and bone grafting was performed. Four cases were diagnosed as single vertebral tuberculosis by clinical diagnosis. The lesions of the vertebral body were removed 2 weeks after anti-TB treatment and iliac bone grafting was performed. Postoperative anti-TB drug treatment for 8 to 10 months. Results: Postoperative pathological examination confirmed that vertebral lesions were tuberculosis. Patients were followed up for 1 to 4 years, with an average of 2 years and 3 months. Erosions returned to normal within half a year, and symptoms of lumbago gradually disappeared. X-rays confirmed that the bone graft healed with an average bone fusion time of 3.8 months. No recurrence of tuberculosis during follow-up. Conclusion: Single vertebra solitary tuberculosis in adults is relatively rare, clinical symptoms and imaging findings are not typical, CT and MRI combined examination can confirm the scope of lesions and bone destruction type, standard anti-TB drug treatment combined with lesion clear vertebral implant Bone can achieve good effect.