四肢关节骨折在急诊CR影像中漏诊原因分析

The analysis of the missed diagnosis of the limbs and joint fracture using radiography in the emergency department

目的:探讨应用CR系统摄影出现四肢关节骨折漏诊的成因。方法:总结2006年6月—2011年4月间搜集的36例因急诊CR首诊漏诊,造成患者一定质疑的完整影像资料,其中男25例,女11例,年龄9～68岁(平均41.5岁)。结果:36例病例中遗漏骨折38处,于当天复查摄片或3～11天后复查时确诊(平均4.9天),其中标准体位投照23例、非标准体位投照13例(外伤骨折后的解剖结构紊乱或被动体位造成)。19例行CT检查、8例行MR检查。结论:造成急诊首诊骨折漏诊的不可避免的原因包括:①局部骨折后解剖结构改变造成影像遮挡而被忽略的其它部位骨折;②因体位原因造成骨质结构影像遮挡而骨折被漏诊;③CR影像不能显示的微细或隐匿骨折。因此规范影像检查操作,充分认识可能出现的问题,紧密结合患者的临床体征,密切随诊或进一步检查可避免不必要的临床纠纷出现。

Objective： To explore the reasons of the missed diagnosis of the limb and joint fracture using CPt system in the emergency department. Methods： Thirty-six cases aged 9-68 years（mean 41.5 years） were included during the period June 2006--April 2011 which caused the dissatisfaction for the missed diagnosis of the limbs fracture in the emergency department. Results： Thirty-eight fractures were missed in the 36 cases~ and the correct diagnosis was made by reviewing the radiography on the same day or after 3-11 days （mean 4.9 days）. Standard position was taken in 23 cases, and non-standard position in other eases. CT was conducted in 19 cases and MR was perfomled in 8 cases. Conclusion： The inevitable reasons for missed diagnosis of the limbs fracture at the first examination in the emergency department rangement. Beeause of the body position of the patients, fracture is hidden by the bony strueture. Subtle fraeture and oc- cult fracture can＇t be displayed by plain radiography. So unnecessary clinical dispute can be avoided by taking standard imagingn, fully understanding of the condition that may occur at the time of trauma, closely examine the clinical sign of the patients, close follow-up or further examination.