隐匿性肱骨头骨折误漏诊七例分析

Analysis for Misdiagnosis and Missed Diagnosis of Seven Patients with Occult Humeral Head Fracture

目的探讨隐匿性肱骨头骨折的误漏诊原因及防范措施。方法回顾性分析我院2013年1月—2017年1月收治的隐匿性肱骨头骨折误漏诊7例的临床资料。结果 7例首发症状均为肩关节局部疼痛伴活动受限,病初X线检查肱骨头均无明显骨折征象,3例诊断为肩关节脱位伴肱骨大结节撕脱性骨折,诊断为肱骨大结节撕脱性骨折及软组织伤各2例,均漏诊肱骨头骨折。误漏诊时间1 d^2周。7例均经肩关节CT检查确诊肱骨头骨折。确诊后,4例行手术内固定治疗,3例行石膏外固定保守治疗。随访6~24个月,骨折均愈合,肩关节功能明显改善。结论隐匿性肱骨头骨折极易误漏诊,对于高度怀疑隐匿性肱骨头骨折而X线检查无明显异常者应进一步行肩关节CT检查,防止误漏诊。

Objective To investigate causes of misdiagnosis and missed diagnosis of occult humeral head fracture and to provide preventive measures.Methods Clinical data of 7 patients with missed diagnosis or misdiagnosis of occult humeral head fracture admitted to our hospital between January 2013 and January 2017 was retrospectively analyzed.Results All the patients complained of shoulder pain with limitation of motion.There were no obvious signs of fracture of the humeral head on the initial X-ray examination.Three patients were diagnosed as shoulder dislocation with avulsion fracture of greater tubercle of humerus,two patients were diagnosed as avulsion fracture of greater tubercle of humerus,and 2 patients diagnosed as soft tissue contusion.All cases were misdiagnosed as humeral head fracture.The duration of misdiagnosis and missed diagnosis was 1 d-2 w.CT scanning of shoulder joint confirmed humeral head fracture in all seven patients.Of them,4 patients received internal fixation,and plaster outer-fixation was performed in 3 patients.At an average follow-up period of 6-24 months,all patients had excellent fracture union,and shoulder function was significantly improved.Conclusion Occult humeral head fracture is easily misdiagnosed or neglected.For those with highly suspected occult humeral head fracture but with negative X-ray findings,CT scan should be performed in order to prevent missed diagnosis or misdiagnosis.