强直性脊柱炎脊柱骨折的延误诊断  

Delayed diagnosis of spine fractures in ankylosing spondylitis

作　　者：姬洪全[1] 周方[1] 田耘[1] JI Hong-quan;ZHOU Fang;TIAN Yun(Department of Othopae-dics,Third Hospital,Peking University,Beijing Key Laboratory of Spinal Disease Research,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科脊柱疾病研究北京市重点实验室,北京100191

出　　处：《中国矫形外科杂志》2022年第4期309-313,共5页Orthopedic Journal of China

摘　　要：[目的]分析强直性脊柱炎(ankylosing spondylitis,AS)患者脊柱骨折延误诊断的原因。[方法]总结2008-2019年本院收治的强直性脊柱炎脊柱骨折延误诊断的患者,分析骨折特点及延误诊断原因。[结果]2008-2019年,本科收治脊柱疾患患者共63573例,其中最终确诊脊柱骨折3363例,占5.29%。脊柱骨折的3363例患者中,最终确诊为AS 166例,占4.94%。最终确诊为AS脊柱骨折的157例患者中,误诊7例,占4.67%,其中,在外院误诊3例,占1.91%,在本院初诊误诊4例,占2.55%。误诊组无明确外伤史的比率显著高于确诊组,差异有统计学意义(P<0.05)。7例误诊患者中,3例因多发脊柱骨折其中一处骨折误诊;2例因外伤不明显症状轻微延迟就诊;1例因颈椎外伤脊髓损伤康复期间胸腰段骨折进展至局部畸形就诊;1例颈椎骨折首诊因身体畸形影像检查不全面,隐匿颈椎骨折误诊。[结论]强直性脊柱炎患者脊柱骨折误诊多见于脊柱多发骨折的患者;其次是外伤轻微症状不典型,未及时就诊的患者;再次是骨折隐匿,影像检查不全面的患者。[Objective]To explore the cause of delayed diagnosis of spinal fractures in ankylosing spondylitis(AS).[Method]The patients with delayed diagnosis(DD)for spinal fracture were searched in our hospital from 2008 to 2019.The fracture characteristics and the causes of DD were analyzed.[Result]From 2008 to 2019,a total of 63573 patients with spinal diseases were admitted to our department,and among them 3363 patients(5.29%)were finally diagnosed with spinal fractures.Of the 3363 patients with spinal fracture,166 patients(4.94%)were finally diagnosed AS.Among 157 patients who were finally diagnosed of AS spinal fracture,7 patients were of delayed diagnosis,accounting for 4.67%,including 3 cases who were misdiagnosed initially in other hospitals,accounting for 1.91%,and 4 cases who were misdiagnosed primarily in our hospital,accounting for 2.25%.The ratio of no definite trauma history in the delayed diagnosis group was significantly higher than in the confirmed diagnosis group,with a statistically significant difference(P<0.05).Among the 7 delayed diagnosed patients,3 patients had one fracture misdiagnosed because of multiple spinal fractures,2 patients were slightly delayed due to non-obvious symptoms of trauma,1 case was treated for local malformation due to thoracolumbar fracture during spinal cord injury rehabilitation,1 case of cervical vertebra facture was misdiagnosed due to incomplete malformation on imaging examination.[Conclusion]Delayed diagnosis of spinal fracture in AS often occurs in patients with multiple spinal fractures,additionally,overlooked occult fracture and delayed presentation are also common reasons for initial misdiagnosis.

关 键 词：强直性脊柱炎 脊柱骨折 延误诊断 

分 类 号：R683.2[医药卫生—骨科学]