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隐匿性骨折的临床特点及误漏诊原因分析 被引量:34

Clinical Features and Causes of Misdiagnosis and Missed Diagnosis of Occult Fractures
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摘要 目的分析隐匿性骨折患者的临床特点及误漏诊原因、防范措施,以提高隐匿性骨折检出率。方法对2008年1月—2013年1月澄合矿务局中心医院收治曾误漏诊的隐匿性骨折18例的临床资料进行回顾性分析。结果18例中2例股骨颈骨折误诊为髋关节扭伤,2例踝关节骨骺损伤误诊为踝关节扭伤,1例股骨颈骨折误诊为股骨头早期无菌性坏死,2例骶尾骨骨折误诊为肛门疾病,2例髌骨纵行骨折误诊为膝关节软组织损伤;1例股骨干骨折并同侧股骨颈骨折漏诊股骨颈骨折,1例脑挫裂伤并颈椎损伤漏诊颈椎损伤,2例股骨干并同侧髋臼骨折均漏诊髋臼骨折,1例右股骨颈骨折合并髋臼后部骨折漏诊髋臼后部骨折,1例胸腔积液并肋骨骨折漏诊肋骨骨折,1例脊柱、脊髓损伤合并不完全性截瘫并踝关节骨折、股骨颈骨折漏诊踝关节骨折、股骨颈骨折,2例股骨转子间骨折合并股骨干、股骨髁骨折漏诊股骨干、股骨髁骨折。误漏诊时间为7~28 d。18例复查(X线、CT或MRI)确诊17例,术中探查确诊1例;确诊后均立即按照骨折治疗原则治疗。随访6~36(12.6±2.4)个月,15例(83.33%)骨折一期愈合,3例治疗后出现并发症。结论医生因素、个人因素、创伤原因、投照及解剖因素均是导致隐匿性骨折误漏诊的原因。加强医患沟通、强化业务训练、严格依据骨科诊疗常规进行查体及影像学分析可减少或避免其误漏诊。 Objective To analyze clinical characteristics,causes of misdiagnosis and missed diagnosis and prevention measures in order to improve detection rates of occult fractures. Methods Clinical data of 18 misdiagnosed or missed diagnosed patients with occult fractures admitted between January 2008 and January 2013 was retrospectively analyzed. Results Among the 18 patients,2 patients with femoral neck fractures were misdiagnosed as having hip joint sprain; 2 patients with ankle joint epiphyseal injury were misdiagnosed as having sprained ankle; 1 patient with femoral neck fracture was misdiagnosed as having early femoral aseptic necrosis; 2 patients with sacrococcyx fractures were misdiagnosed as having anal diseases; 2 patients with patella longitudinal fractures were misdiagnosed as having knee joint soft tissue injury; 1 patient with femoral shaft fractures complicated with ipsilateral femoral neck fracture was missed diagnosis of femoral neck fracture; 1 patient with cerebral contusion and laceration complicated with cervical spine injury was missed diagnosis of cervical spine injury; 2 patients with femoral shaft complicated with ipsilateral acetabular fractures were missed diagnosis of acetabular fractures; 1 patient with right femoral neck fractures complicated with posterior acetabular fractures was missed diagnosis of acetabular posterior column occult fractures; 1patient with pleural effusion complicated with rib fracture was missed diagnosis of rib fracture; 1 patient with spinal injury,spinal cord injury complicated with incomplete paraplegia with ankle joint fracture and femoral neck fractures was missed diagnosis of ankle joint and femoral neck fractures; 2 patients with femoral intertrochanteric fracture complicated with femoral shaft and femoral condyle fractures were missed diagnosis of femoral shaft and femoral condyle fractures. Time of misdiagnosis and missed diagnosis was 7-28 d. Among the 18 patients,17 patients were confirmed by X-ray,CT or magnetic resonance imaging( MRI)review,and 1 patients was confirmed by intraoperative probing. All patients were immediately treated in accordance with the principles of fracture treatment after confirmed diagnosis. During 6-36( 12. 6 ± 2. 4) months of follow-up,15 patients( 83. 33%) had primary healing,and 3 patients had complications after treatment. Conclusion Causes of misdiagnosis or missed diagnosis of occult fractures are doctor factor,individual factor,causes of trauma,projection and anatomic factors,and misdiagnosis and missed diagnosis can be decreased by strengthening communication between doctors and patients,enhancing professional training,strictly performing routine physical examination and imaging analysis.
出处 《临床误诊误治》 2016年第11期26-30,共5页 Clinical Misdiagnosis & Mistherapy
基金 陕西省科学技术研究发展计划项目(2012K16-09-03)
关键词 骨折 误诊 漏诊 Fractures Misdiagnosis Missed diagnosis
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