骨质疏松性椎体压缩性骨折误诊临床分析

Clinical Analysis of Misdiagnosis of Osteoporotic Vertebral Compression Fracture

目的探讨骨质疏松性椎体压缩性骨折(OVCF)的临床特点和误诊原因、防范措施。方法回顾性分析2022年2月—2023年4月收治的曾误诊的OVCF 14例的临床资料。结果本组以季肋部疼痛为主诉就诊7例,以嗳气、食欲减退、腹痛和腹胀等消化系统症状为主诉就诊7例。7例腰背部叩击痛,8例腹部膨隆、叩诊呈鼓音,肠鸣音减弱。7例X线检查仅发现胸腰椎侧弯。首诊误诊为胃肠神经官能症和肋间神经痛各7例。给予相应治疗效果不佳转我院。误诊时间12~20 d。后经询问病史及胸腰椎MRI检查等确诊OVCF。给予骨质疏松相关药物治疗并行后路经皮胸腰椎后凸成形术后症状完全缓解或消失;术后6个月复查椎体愈合,脊柱活动基本正常。结论OVCF易误诊。临床接诊无明显外伤史,以季肋部疼痛或消化系统症状就诊患者时,应仔细查体,详细询问病史及疼痛特点,尽早行X线或MRI检查,且注意勿被早期X线检查骨折阴性干扰诊断,以降低OVCF早期误诊率。

Objective To investigate the clinical characteristics,causes of misdiagnosis and preventive measures of osteoporotic vertebral compression fracture(OVCF).Methods The clinical data of 14 patients with OVCF who had been misdiagnosed from February 2022 to April 2023 were retrospectively analyzed.Results In this group,the main complaint of 7 patients was hypochondriac pain,and the main complaint of 7 patients was digestive symptoms such as belching,loss of appetite,abdominal pain and abdominal distension.There were 7 patients with low back percussion pain,8 patients with abdominal distension,percussive sound,and weakened intestinal sound.X-ray examination found only thoracolumbar scoliosis in 7 patients.The initial diagnosis was misdiagnosis as gastrointestinal neurosis and intercostal neuralgia in 7 cases respectively.The corresponding treatment was not effective and they were transferred to our hospital.The misdiagnosis lasted 12-20 d.OVCF was confirmed by medical history and MRI of thoracolumbar vertebrae.After drug treatment with osteoporosis-related drugs and posterior percutaneous thoracolumbar kyphoplasty,the symptoms were completely relieved or disappeared.Vertebral healing was reviewed at 6 months after surgery,and spinal movement was basically normal.Conclusion OVCF is prone to misdiagnosis.When receiving patients with no obvious history of trauma and presenting them with symptoms of hypochondriac pain or digestive system,careful physical examination should be conducted,detailed medical history and pain characteristics should be inquired,X-ray or MRI examination should be performed as soon as possible,and attention should be paid not to be interfered with the diagnosis of negative fracture by early X-ray examination,so as to reduce OVCF.