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
李志强 1金合 1李春根 2曾俊1
作者信息
- 1. 102100 北京,北京中医医院延庆医院(北京市延庆区中医医院)骨伤科
- 2. 102100 北京,首都医科大学附属北京中医医院骨伤科
- 折叠
摘要
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.
Abstract
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 pre-ventive 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 in-cluded hypochondriac pain in 5 cases,digestive system symptoms such as belching,loss of appetite,abdominal pain and ab-dominal 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 de-generation 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 ky-phoplasty 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 examina-tion 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 ex-amination 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.
关键词
骨折,压缩性/骨质疏松性骨折/中老年/误诊/肋间神经痛/慢性胃炎/脊椎退行性病变/磁共振成像Key words
Fractures,compression/Osteoporotic fractures/Middle-aged and elderly/Misdiagnosis/Intercostal neuralgia/Chronic gastritis/Spinal degenerative disease/Magnetic resonance imaging引用本文复制引用
出版年
2023
国家科技期刊平台
NSTL
万方数据