髌骨纵行骨折临床表现及误漏诊原因分析

Clinical Manifestations and Causes of Misdiagnosis and Missed Diagnosis of Patients with Longitudinal Patellar Fracture

目的探讨髌骨纵行骨折的临床特点、误漏诊原因及防范措施。方法回顾性分析2016年4月—2021年5月收治的曾误诊或漏诊髌骨纵行骨折16例的临床资料。结果本组误漏诊率为14.68%。16例患膝均明显肿胀,4例无皮损,膝关节活动明显受限5例,轻度受限9例,无受限2例。16例髌前方压痛程度不一,14例压痛明显,麦氏征阴性。16例均行膝关节正侧位X线检查,未见骨折线11例,5例显示骨折线。误诊为膝关节软组织损伤10例、滑膜损伤3例,合并半月板损伤、交叉韧带损伤、股骨髁间骨折各1例漏诊。误漏诊时间2~10 d。入院后4例行髌骨轴位X线检查,12例行膝关节CT检查后发现骨折线,确诊为髌骨纵行骨折。15例予以石膏外固定治疗,1例合并股骨髁间骨折行手术治疗,随访1年预后较好。结论髌骨纵行骨折较少见,缺乏典型症状体征,膝关节正侧位X线检查诊断效能低,初诊时常有误漏诊发生;提高接诊医生尤其是基层医院医生对该病的认知,详细询问病史,完善体格检查,并及早行针对性医技检查,有助于本病及早确诊。

Objective To investigate clinical characteristics,causes of misdiagnosis and missed diagnosis and preventive measures of patients with longitudinal patellar fracture.Methods Clinical data of 16 misdiagnosed or missed diagnosed patients with longitudinal patellar fracture who had been admitted between April 2016 and May 2021 was retrospectively analyzed.Results The rate of misdiagnosis or missed diagnosis was 14.68%in this group.The knees of 16 patients were obviously swollen;4 patients had no skin lesions;5 patients had obvious limitation of knee joint movement,9 patients had mild limitation and 2 patients had no limitation.All the 16 patients had different degrees of anterior patella tenderness,and 14 patients had obvious tenderness,and the Mai’s sign was negative.All the 16 patients underwent X-ray examination of the anterior and lateral positions of the knee joint.No fracture line was found in 11 patients,and 5 patients showed fracture lines.There was misdiagnosis as soft tissue injury of knee joint in 10 patients,synovium injury in 3 patients,and meniscus injury,cruciate ligament injury and femoral intercondylar fracture were missed diagnosis in 1 patient respectively.The duration of misdiagnosis or missed diagnosis was 2-10 d.After admission,4 patients underwent axial X-ray examination of the patella,and 12 patients underwent knee CT examination,and the fracture line was detected,and then longitudinal patellar fracture was confirmed.Of them,15 patients were treated with plaster external fixation,and 1 patient combined with femoral intercondylar fracture received surgery.The prognoses of all patients were favorable with one-year of follow-up.Conclusion Longitudinal patellar fracture is rare and lack of typical symptoms and signs,and X-ray examination of anterior and lateral positions of knee joint has poorly diagnostic efficiency,and therefore,misdiagnosis and missed diagnosis are often occur at initial diagnosis.It is necessary to improve the awareness of doctors,especially the doctors in primary hospitals,inquire about the medical history in detail,improve the physical examinations and conduct targeted laboratory examinations as soon as possible,which will help the early diagnosis of the disease.