非特种职业者疲劳性骨折的误诊原因分析

Causes of misdiagnosis of fatigue fracture in nonspecific occupation

目的分析非特种职业者疲劳骨折的误诊原因,寻找诊断策略。方法回顾分析13例误诊的非特种职业者疲劳骨折的临床影像学资料。13例均行X线平片检查,其中CT检查10例,MRI检查8例,同位素骨扫描4例。结果 13例疲劳性骨折发生于胫骨7例,腓骨2例,跟骨1例,肋骨2例,坐骨结节1例;单侧11例,双侧2例。13例首次X线平片检查,漏诊6例,诊断不清1例,误诊6例;10例首次CT检查,漏诊2例,误诊3例。8例首次MRI检查中,误诊5例。4例同位素骨扫描检查,误诊或诊断不明确各2例。误诊原因可能包括:对此病认识或重视不足、病史询问不够详细、检查方法选择不当以及影像学征象认识不够准确。结论密切结合临床病史,合理选择检查方法并掌握其影像学征象,有助于及时对非特种职业者疲劳骨折作出正确诊断。

Objective To explore the causes of misdiagnosis of fatigue fracture on nonspecific occupational patients and look for diagnostic strategies. Methods Retrospective analysis was done on clinical imaging data of misdiagnosed fatigue fracture from 13 cases of nonspecific occupation. All of the 13 patients underwent X-ray examination, at the same time, some of the patients received CT scans （n=10）, MRI examination （n=8）, and bone isotope scan （n=4）. Results Among 13 cases of fatigue fracture, 7 cases occurred in the tibia, 2 in fibula, 1 in calcaneus, 2 in rib, and 1 in ischial tuberosity. 11 of 13 cases were unilateral fractures and 2 were bilateral fractures. Of all initial X-ray examination of the 13 cases, 6 were missed diagnosis, 1 was unclear diagnosis and 6 were misdiagnosis. While among all initial CT scans of the 10 cases, 2 were missed and 3 were wrongly diagnosed. 5 of 8 cases＇ initial MRI examination were misdiagnosed. Of 4 cases examined with bone isotope scan, 2 cases were misdiaguosed and 2 were diagnosed unclearly. Causes of misdiagnosis could be composed of insufficient knowledge and attention towards the disease, non detailed medical history, improper choice of examination method and failure to carry out imaging signs. Conclusions Close correlation with clinical history, appropriate examination methods and accurate imaging identification contribute to a correct and timely diagnosis of fatigue fracture in nonspecific professionals.