原发性骶骨肿瘤误诊的原因分析

Analysis of the Causes of Misdiagnosis in Primary Tumors of the Acrum

目的 分析原发性骶骨瘤误诊原因并探讨其早期诊断方法。方法 回顾性分析11例原发性骶骨瘤误诊原因,结合文献提出早期诊断方法。结果 11例中误诊为腰间盘突出症的6例,误诊为一般腰腿痛的2例,误诊为骶椎结核、下肢深静脉血栓及直肠炎的各1例。有2例分别进行多次腰间盘摘除术,3例长期保守治疗以致延误病情。结论 对原发性骶骨瘤的认识不足,缺乏仔细的体格检查和必要的辅助检查,导致误诊。对那些久治不愈的慢性腰腿痛、腰椎间盘突出或下腰痛、慢性腰腿痛伴有单侧下肢外旋畸形或髋关节呈屈曲畸形者,特别是伴有便秘及尿失禁者,应高度怀疑骶骨肿瘤的存在。

Objective To analyse the causes of misdiagnosis of primary tumors of the acrum and find some methods of early diagnosis. Methods and results In a review of the history records of 29 patients, 11 were misdiagnosed; of them 4 were mis-diagnosed as lumbar disc protrusion,2 as lumbar-sacral pain,1 as tuberculosis of lumbar spine,1 as thrombophlebitis of leg,and 1 as proctitis.2 cases were operated upon repeatedly on the diagnosis of lumbar disc protrusion,and 3 had conservative treatment resulting in a delay of the proper management. Conclusion Lack of experience, detailed examination and careful observation of the X-ray, films CT and MRI were the causes of misdiagnosis. In those patients with persistent chronic lumbago associated with unilateral external rotation deformity of the lower extremities or flexion deformity of the hip joint, especially those associated with constipation and urinary incontinence, the diagnosis of tumors of the acrum is highly suspicious.