多间隙腰椎间盘突出症漏诊误诊原因分析及对策

Analysis of Multiple Level Lumbar Disc Herniation Misdiagnosis

目的 :分析多间隙腰椎间盘突出症的漏诊、误诊原因及预防对策 ,提高诊断水平。方法 :回顾性分析 83例多间隙腰椎间盘突出症患者的病史及理学检查 ,影像学资料及再手术原因 ,总结并分析多间隙腰椎间盘突出症常见的漏诊、误诊原因。结果 :多间隙腰椎间盘突出症以下腰椎相邻双间隙多见 ,因病史及理学检查漏误诊 43例 ,漏误诊率 5 2 %( 43/83) ,因脊髓造影检查漏误诊 5例 ,漏误诊率 14 % ( 5 /35 ) ,CT检查漏误诊 15例 ,漏误诊率 2 5 % ( 15 /60 ) ,MRI检查漏诊 0例 ,其中再手术者 7例。结论 :提高对本病的认识 ,详细的病史及理学检查 ,足够的影像学检查 ,合理的检查手段 ,正确的资料分析是提高多间隙腰椎间盘突出症诊断水平的关键。

Objective:To analyze of multiple level lumbar disc herniation misdiagnosis and improve diagnosis level.Method:83 cases who had mul tiple levels lumbar disc herniation were analyzed with symptoms,signs,image data and cause of operation.Result:In these cases double level group at L4/5 associa ted with L_5/S_1,and L_3/4 with L_4/5 was most commanly seen.43 cases were m isdiagnosed by symptoms and signs.The rate of misdiagnosis is 52%.5 cases (15%) were misdiagnosed by myelography,CT misdiagnosis were 15 cases(25%) and MRI exam ination had no case misdiagnosed.In these patients,7 cases required a second ope ration.Conclusion:The key of improving diagnostic level of multiple level lumbar d isc herniation should enhance recognization of this illness,pay attention to de tail somatoscopy,check enough to image examination,correct examination method an d exact analysis of information.