延误诊治减压性骨坏死案例分析

Case analysis of delayed diagnosis and treatment of dysbaric osteonecrosis

目的分析1例延误诊治的减压性骨坏死病例。方法结合患者的职业史、急性减压病病史和影像学检查资料,根据GBZ 24—2006《职业性减压病诊断标准》进行诊断。结果患者有明确的潜水作业史,有1979年从事潜水作业后减压不当导致急性减压病病史,主诉有双髋关节疼痛和左下肢行走困难,体格检查可见双髋关节活动受限和左下肢行走不利,双下肢和髋关节X射线摄片和CT检查可见特征性的股骨头和髋关节损害的影像学表现,经综合分析,没有证据否定其从事潜水作业(特别是有减压不当史)与其骨和关节损害之间的必然联系,诊断为职业性减压病(Ⅲ期减压性骨坏死)。结论诊断的延误不利于疾病的及时治疗,不利于控制病情进展和减少伤残发生。

Objective To analyze the delayed diagnosis and treatment on a case of dysbaric osteonecrosis. Methods According to GBZ 24-2006 Diagnostic Criteria of Occupational Decompression Sickness, the patient was diagnosed based on his occupational history, the fact of acute decompression sickness and the image data. Results The patient had a clear history of diving operation and acute decompression sickness due to inappropriate decompression after diving in 1979, and he showed his chief complaints of double hip joint pain and walking difficulty in the left lower limb. Physical examination showed activity limitation in the double hip joint and walking inconvenience in the left lower limb. Images of X-ray photograph and CT examination on double lower limbs and hip joints showed peculiar imaging features of femoral head and hip joint injury. After the comprehensive analysis, there was no evidence found to deny the positive connection between his diving operation （ especially his history of inappropriate decompression） and injury of hones and joints. And the case was finally diagnosed as the occupational decompression sickness （ stage Ⅲ dysbaric osteonecrosis）. Conclusion Delayed diagnosis is harmful to the timely treatment and progress control of the disease, which would increase the possibility of disablement.