中老年不典型骨质疏松椎体压缩性骨折误诊原因分析

Analysis of Misdiagnosis of Atypical Osteoporotic Vertebral Compression Fracture in the Middle-aged and Elderly

目的 分析中老年不典型骨质疏松椎体压缩性骨折的临床特点、影像学表现,总结发生误诊的原因及防范措施。方法 回顾分析2019年3月—2021年5月收治的早期曾误诊的中老年骨质疏松椎体压缩性骨折11例的临床资料。结果 11例中以季肋部疼痛为主诉就诊5例,以嗳气、食欲减退、腹痛、腹胀等消化系统症状为主诉就诊2例,以腰背部酸痛为主诉就诊4例。均无明显外伤史。4例行X线检查,2例行胃镜检查。误诊为肋间神经痛5例、脊椎退行性病变4例、慢性胃炎2例。入院后依据胸腰椎MRI检查结果及伤椎棘突叩击痛阳性,确诊为中老年骨质疏松性椎体压缩性骨折。误诊时间12~20 d。确诊后行后路经皮胸腰椎后凸成形术,术后恢复良好。结论 部分中老年骨质疏松椎体压缩性骨折早期症状不典型,无明显外伤史,早期X线检查阴性率高,易误诊。对中老年(>50岁)以胸腰背部疼痛或阵发性季肋部疼痛为主要症状就诊者,应详细询问病史、仔细查体,了解疼痛的特点及诱因,并及早行椎体MRI检查,以防误诊。

Objective To analyze the clinical features and imaging manifestations of atypical osteoporotic vertebral compression fractures(OVCF)in the middle-aged and elderly patients,and to summarize the causes of misdiagnosis and preventive measures.Methods The clinical data of 11 middle-aged and elderly patients with OVCF who had been misdiagnosed in the early stage from March 2019 to May 2021 were retrospectively analyzed.Results The main complaint of 11 cases included hypochondriac pain in 5 cases,digestive system symptoms such as belching,loss of appetite,abdominal pain and abdominal distension in 2 cases,and low back pain in 4 cases.There was no obvious history of trauma.Four patients underwent X-ray examination and 2 patients underwent gastroscopy.There was misdiagnosis as intercostal neuralgia in 5 cases,spinal degeneration in 4 cases,and chronic gastritis in 2 cases.After admission,the patient was diagnosed with OVCF in the middle-aged and elderly according to the results of MRI examination of thoracolumbar spine and positive percussion pain in the spinous process of the injured vertebra.The misdiagnosis lasted 12-20 d.After diagnosis,posterior percutaneous thoracolumbar kyphoplasty was performed,and postoperative recovery was good.Conclusion The early symptoms of some middle-aged and elderly patients with OVCF are not typical,there is no obvious history of trauma,and the negative rate of early X-ray examination is high;therefore,OVCF is more likely to be misdiagnosed.For middle-aged and elderly(>50 years old)patients with chest,lumbar and back pain or parochial hypochondriac pain as the main symptom,detailed medical history and physical examination should be conducted to understand the characteristics and causes of pain,and vertebral MRI examination should be performed as soon as possible to prevent misdiagnosis.