距骨骨折漏诊七例分析

Cause analysis and treatment strategy of missed diagnosis of talus fractures

目的分析距骨骨折漏诊原因，探讨预防对策，降低距骨骨折漏诊率。方法2007年至2012年距骨骨折初次就诊后漏诊的7例，其中距骨体骨折2例，距骨颈骨折5例，所有患者均经CT扫描和二维、三维重建后确诊，7例骨折均未愈合。结果7例均获平均10（6～20）个月的随访，术后x线片复查显示骨折愈合的平均时间为14周，所有患者均愈合，AOFAS评分由术前33．4分上升至术后85．3分。结论检查足踝关节创伤时，结合病史，除选择适当的投照条件外，结合CT检查可以减少漏诊率。

Objective To analyze the causes for missed diagnosis of talus tractures, to lnvesugate me preventive measures and to reduce the rate of missed diagnosis of talus fractures. Methods From 2007 to 2012, among the 7 cases of talus fractures which were misdiagnosed after the first-time consultancy, there were 2 cases of talar body fractures and 5 cases oftalar neck fractures. The diagnosis for all patients was confirmed by CT scan and 2-dimensional and 3-dimensional reconstruction, and bone union was not achieved. Results 7 patients were followed up for a mean period of 10 months （ range; 6-20 months ）. The postoperative X-ray examination showed the average healing time was 14 weeks, and all patients gained bone union. The American Orthopaedic Foot and Ankle Society （ AOFAS ） score was improved from 33.4 points preoperatively to 85.3 points postoperatively. Conclusions When checking foot and ankle trauma, surgeons should pay attention to the medical history of the patients and selecting the appropriate projection conditions. In addition, the rate of misdiagnosis could be reduced with the CT examination.