骨质疏松性胸腰椎骨折患者的临床特征及漏诊影响因素分析

Analysis of clinical features and influencing factors of missed diagnosis in patients with osteoporotic thoracolumbar fracture

目的研究骨质疏松性胸腰椎骨折(OTF)患者的临床特征及及漏诊影响因素。方法纳入我院收治的OTF患者108例,根据首诊中是否出现漏诊情况将其分为漏诊组(45例)和确诊组(63例)。比较两组的临床特征;分析OTF患者漏诊的危险因素;分析OTF漏诊与确诊患者的共性中医症候特征。结果两组的外伤情况、单椎体骨折、叩击痛1~2级、疼痛程度占比比较,差异具有统计学意义(P<0.05);两组的年龄、性别、发病时间、便秘、活动受限、慢性腰背痛、发病至就诊时间≥3 d占比比较,差异无统计学意义(P>0.05)。二元Logistic回归分析结果显示,外伤情况、单椎体骨折、叩击痛1~2级、疼痛程度均为影响OTF患者漏诊率的独立危险因素(P<0.05)。OTF患者中,经诊断肾阳虚53例,肾阴虚55例;两组患者的中医证候分布情况比较,差异无统计学意义(P>0.05)。结论外伤情况、单椎体骨折、叩击痛1~2级、疼痛程度均与OTF患者漏诊明显相关;同时,临床中对于年龄≥70岁、女性、春秋冬季发病、便秘、活动受限、慢性腰背痛、发病至就诊时间≥3 d、肾阳虚和肾阴虚等特征的患者,应高度重视早期OTF的发生,必要时开展MRI检查,以减少OTF的漏诊。

Objective To study clinical features and influencing factors of missed diagnosis in patients with osteoporotic thoracolumbar fracture(OTF).Methods A total of 108 OTF patients admitted in our hospital were divided into missed diagnosis group(45 cases)and confirmed diagnosis group(63 cases)according to whether missed diagnosis occurred during the first diagnosis.The clinical features of the two groups were compared;the risk factors for missed diagnosis of OTF patients were analyzed;the features of common symptom of traditional Chinese medicine of missed diagnosis and confirmed diagnosis of OTF patients were analyzed.Results There were statistically significant differences in the proportions of trauma,monopyramid fracture,percussion pain with grade 1-2 and pain degree between the two groups(P<0.05);there were no significant differences in the proportions of age,gender,onset time,constipation,activity restriction,chronic lumbago and time≥3 d from onset to visit between the two groups(P>0.05).The results of binary Logistic regression analysis showed that trauma,monopyramid fracture,percussion pain with grade 1-2 and pain degree were all independent risk factors affecting the missed diagnosis rate of OTF patients(P<0.05).Among OTF patients,53 cases were diagnosed as kidney-Yang deficiency and 55 cases as kidney-Yin deficiency;there was no significant difference in symptom distribution of traditional Chinese medicine between the two groups(P>0.05).Conclusion Trauma,monopyramid fracture,percussion pain with grade 1-2 and pain degree were significantly correlated with missed diagnosis of OTF patients.At the same time,high attention should be paid to the occurrence of early OTF in patients with clinical features of age≥70 years old,female,onset in spring,autumn and winter,constipation,activity restriction,chronic low back pain,time≥3 d from onset to visit,kidney-Yang deficiency and kidney-Yin deficiency,and MRI examination should be carried out when necessary to reduce the missed diagnosis of OTF.