胸腰椎爆裂骨折急诊漏诊的原因分析及对策

Analysis and countermeasures on the thoracolumbar burst fractures missed in emergency

目的：回顾性分析2006~2013年急诊接诊胸腰段创伤资料,找出合理应用放射影像学检查的方法,为减少脊柱爆裂骨折漏诊提供经验。方法：2006~2013年我院共接诊胸腰部外伤病例1 311例,患者平均年龄38.5岁。按有无神经损伤症状体征进行分组统计,其中无神经症征组954例,有神经症征组357例。胸腰椎影像学检查：X光正侧位（CR）、CT横贯扫描及三维成像,少部分做MRI检查。结果：1 311例患者总诊断率24.87%。无神经症征组诊断率12.37%,漏诊率9.32%;有神经症征组诊断率58.26%,漏诊率0。单纯按CR检查者统计：无神经症征组诊断为爆裂骨折118例,检出率7.63%;有神经症征组诊断为爆裂骨折208例,检出率9.62%。前述2组CR与使用CT影像学检查对爆裂骨折的检出率（86.44%和90.38%）比较差异有统计学意义（χ2=171.34和χ2=323.56,P〈0.01）。结论：应用CR检查诊断脊柱爆裂骨折有一定的困难,极少有肯定的诊断价值。CT检查简便、快捷,在了解骨折线方向、骨碎片移位、椎弓骨折、椎管形态及狭窄程度等方面则有明显的优势,应该是作为诊断脊柱爆裂骨折的首选。

Objective：A review of 8years of thoracolumbar trauma emergency admissions data,to find out the reasonable application of radiographic inspection method and to provide reduced spine burst fracture missed diagnosis experience.Method：From 2006 to 2013,a total of 1 311 cases of thoracolumbar trauma admissions,average age is 38.5years old.There are no signs and symptoms were grouped according to statistical neural injury.Where no nerve syndrome group 954 cases,with 357 cases of neurosis in syndrome group.Examination of thoracic and lumbar imaging：X-ray front and side checking（CR）,CT across scan and 3Dimaging,a small part of the MRI examination.Result：Of the 1 311 patients,the total diagnostic rate of 24.87%.No neurologic syndrome group 954 cases diagnosis rate was 12.37%,the missed diagnosis rate is 9.32%.There are 357 cases of neurosis in patients,the diagnosis rate of 58.26%,missed diagnosis rate is 0.As a pure CR Examination Statistics：no nerve syndrome group diagnosed 118 cases of burst fracture,the detection rate of 7.63%;nerve syndrome group diagnosed 208 cases of burst fracture,the detection rate of 9.62%.The two group of CR with the use of CT imaging detection rate of burst fractures（86.44% and 90.38%）compared to a very significant difference（χ2=171.34andχ2=323.56,P〈0.01）.Conclusion：The application of CR examination in the diagnosis of spinal burst fracture has the certain difficulty,there are very few definite diagnostic value.CT examination is simple and fast,it has obvious advantage in understanding the direction of fracture line,fracture displacement,fracture of vertebral arch,the degree of stenosis of spinal canal morphology and other aspects,should be used as diagnosis of spinal burst fracture of choice.