445例颈痛误诊文献回顾性分析及思考

Retrospective Analysis of Misdiagnosed Literature in 445 Cases with Neck Pain and Reflection

目的分析以颈痛为主诉相关疾病的误诊情况及原因,并进一步探讨中西医不同的诊断思路及减少误诊的对策,以助针灸医师提高对本病的认识。方法系统检索以颈痛为主诉的误诊文献,运用数据挖掘的方法对文献进行回顾性分析,梳理中西医不同的诊断思路及减少误诊的个性化对策。结果①经检索后共纳入126篇病例报道,累计误诊445例病例。误诊疾病共涉及9个系统,38个病种,其中以颈椎病的误诊诊断最多。确诊疾病共涉及7个系统、46个病种,以肿瘤、亚急性甲状腺炎、茎突综合征、急性心肌梗死、胸廓出口综合征为主要被误诊疾病。②本病误诊原因多样,以临床症状不典型、对疾病的认识不足、因临床少见病而缺少认识、查体及辅助检查不详细或存在错误性导向等为主要误诊原因。③颈痛的误诊诊断多样,延误病情甚至可危及生命,明确诊断是中西医治疗取得疗效的前提和基础。结论本病存在多种误诊可能,应仔细采集病史、完善专科查体和辅助检查,注重整体思维及鉴别诊断。针灸科作为颈痛患者就诊的主要科室,为提高颈痛的诊疗水平,要求针灸医师夯实西医的颈痛诊断思路,紧扣中医“三辨病”的“辨病论治”原则,以期减少误诊、治病求本、提高远期疗效。

Objective Analysis of misdiagnosis and causes of neck pain related diseases,and to explore the different diagnostic ideas of Chinese and Western medicine and the countermeasures to reduce misdiagnosis,so as to help acupuncturists improve their understanding of this disease.Method The relevant literature on conditions with neck pain as the chief complaint was systematically searched,using data mining for retrospective analysis,sorting out the different diagnostic ideas of Chinese and Western medicine,proposing individualized countermeasures for reducing misdiagnosis.Results①After retrieval,126 case reports were included,totaling 445 cases of diagnostic error,involving 9 systems and 38 conditions,of which cervical spondylosis was the most commonly misdiagnosed.The confirmed cases involved 7 systems and 46 conditions,of which tumors,subacute thyroiditis,eagle syndrome,acute myocardial infarction and thoracic outlet syndrome were the most commonly misdiagnosed.②The are various causes for the misdiagnosis of this condition,including atypical symptoms,insufficient understanding of the condition,lack of understanding of rare conditions,incomplete physical and auxiliary examina-tions,or wrong guidance.③There are many erroneous diagnosis of neck pain,which can delay the condition and even endanger lives.A clear diagnosis is the premise and basis for effective Traditional Chinese and Western medical intervention.Conclusion There exists a number of possibilities for the misdiagnosis of this disease.Therefore,we must meticulously collect medical history,improve specialist physical and auxiliary examination,emphasizing holistic thinking and differential diagnosis.Acupuncture department as the main department of patients with neck pain,in order to improve the level of diagnosis and treatment of neck pain,requires acupuncturists to consolidate the Western medicine diagnosis of neck pain,closely linked to the Traditional Chinese Medicine"three principles"of"treatment based on disease differentiation",in order to reduce misdiagnosis,cure the disease,improve long-term efficacy.