9例骨软化症临床误诊分析

Analysis of 9-case misdiagnosis of osteomalacia

目的通过骨软化症的误诊原因分析,提高临床对该病的诊治水平,使其能够被早期诊断与治疗。方法采用病例回顾的方法,分析9例骨软化症的临床资料,包括一般资料、临床表现、实验室检查、影像检查、误诊情况及治疗转归等。结果 9例患者均被误诊为严重骨质疏松症,其中3例被误诊为强直性脊柱炎,2例被误诊为腰椎间盘突出症,3例被误诊为无菌性股骨头坏死,1例误诊为肿瘤骨转移。在明确诊断为骨软化症之前,治疗效果不佳。确诊后,按骨软化症采取相应治疗,病情显著改善。结论骨软化症在临床上非常容易与以骨痛、身体活动受限、脆性骨折等为主要临床表现的骨质疏松症相混淆而误诊为骨质疏松症及其他疾病。临床对于以骨痛、脆性骨折、骨骼畸形、活动受限和肌无力为主要表现的就诊患者,应进行全面检查,可以鉴别诊断,减少误诊的发生。

Objective By analyzing the reasons for the misdiagnosis of osteomalacia, to improve the diagnosis and treatment level of this disease, in order to diagnose and treat this disease at early stage. Methods The clinical data of 9 patients with osteomalaeia were retrospectively analyzed, including general information, clinical manifestations, laboratory tests, imaging, misdiagnosis, and the treatment effect. Results All these 9 patients were misdiagnosed as severe osteoporosis. Among them, 3 were misdiagnosed as ankylosing spondylitis, 2 were misdiagnosed as lumbar disc herniation, 3 were misdiagnosed as aseptic osteonecrosis of the femoral head, and 1 was misdiagnosed as bone metastases. Treatments were ineffective until a clear diagnosis of osteomalacia. After a definite diagnosis, the corresponding treatment of osteomalacia was performed and the condition improved significantly. Conclusion Osteomalacia is easily confused with osteoporosis, with the main clinical manifestations of bone pain, limited physical activity, and brittle fractures. For the patients with main manifestations of bone pain, brittle fracture, bone deformities, limited mobility, and muscle weakness, a comprehensive inspection should be conducted, in order to differentiate the diagnosis and reduce the incidence of misdiagnosis.