髌骨纵行骨折的误诊原因及防范对策

Misdiagnosis Causes of Longitudinal Patella Fractures and Preventive Measures

目的分析髌骨纵行骨折的临床特点及误诊原因,总结防范误诊措施。方法对2018年1月—2020年5月收治的16例髌骨纵行骨折中曾误诊5例的临床资料进行回顾性分析。结果本组误诊率为31.25%,4例因单侧膝关节肿痛伴稍许伸屈活动受限入院,1例因车祸致左膝关节肿痛、活动受限入院。误诊为膝关节软组织损伤2例,股骨髁间骨折、半月板损伤及滑膜皱襞损伤各1例,误诊时间为2~14(6.04±0.16)d。5例按误诊疾病予对应治疗效果不佳或进一步加重后完善相关检查均确诊为髌骨纵行骨折,确诊后4例行患肢后侧长腿石膏托外固定,3~4周拆除石膏,行患肢主动功能锻炼好转后出院;另1例行髌外侧小切口,改良张力带横行固定治疗,好转后出院。5例出院后随访半年,功能均恢复正常。结论髌骨纵行骨折发病率较低,缺乏典型临床症状体征,初诊时常易漏误诊;提高对该病的认知,完善体格检查与相关影像学检查,并准确掌握本病的主要阳性体征,强调摄髌骨轴位X线片的重要性与必要性,以降低临床误诊率。

Objective To analyze the clinical characteristics and misdiagnosis causes of longitudinal fracture of the patella,and to summarize the measures to prevent misdiagnosis.Methods The clinical data of 5 misdiagnosed cases in 16 cases with longitudinal patellar fractures admitted from January 2018 to May 2020 were retrospectively analyzed.Results The misdiagnosis rate in this group was 31.25%.Four cases were admitted to the hospital due to unilateral knee joint swelling and pain with slight limitation of extension and flexion,and 1 case was admitted to the hospital due to left knee joint swelling and pain and limitation of motion caused by traffic accident.Of them,2 cases were misdiagnosed as knee joint soft tissue injury,1 case as femoral intercondylar fracture,1 case as meniscus injury,and 1 case as synovial fold injury.The duration of misdiagnosis was 2-14(6.04±0.16)days.According to the misdiagnosed disease,the corresponding treatment was far from satisfactory,or the related examinations were performed due to further aggravation.All patients were diagnosed as longitudinal patella fracture.After diagnosis,4 cases underwent external fixation of the long leg cast on the back of the affected limb.The cast was removed in 3 to 4 weeks.The affected limb was improved after active functional exercise and the patient was discharged.Another case underwent a small incision on the lateral side of the patella.The modified tension band was fixed horizontally,and patients was discharged after recovery.Five patients were followed up for six months after discharge,and their functions recovered.Conclusion The incidence of longitudinal patella fractures is low.Due to lack of typical clinical symptoms and signs,it is often missed during initial diagnosis.Doctors should improve their awareness of the disease,improve physical examination and related imaging examinations,accurately grasp the main positive signs in the diagnosis of the disease,and emphasize the importance and necessity of axial X-rays of the patella to reduce the rate of clinical misdiagnosis.