骨转移瘤致颈肩腰腿痛误诊病例分析与预警对策  

Analysis of misdiagnosed cases of neck,shoulder,waist and leg pain caused by bone metastases and early warning measures

作　　者：钟伟兴 谌祖江[1] 李义凯[1] Zhong Weixing;Chen Zujiang;Li Yikai(Traditional Chinese Medicine Department of Orthopedics and Traumatology,School of Traditional Chinese Medicine,Southern Medical University,Guangzhou 510515,Guangdong Province,China)

机构地区：[1]南方医科大学中医药学院中医骨伤科教研室,广州510515

出　　处：《中国基层医药》2023年第3期371-374,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨骨转移瘤致颈肩腰腿痛的误诊原因,以提高门诊诊断率。方法对南方医科大学第三附属医院中医骨伤科2019年1月至2020年7月诊治的骨转移瘤误诊病例5例进行回顾性研究,分析其临床表现、诊断(外院诊断与门诊诊断)和影像学表现。结果5例骨转移瘤患者分别被误诊为颈椎病、腰椎间盘突出症、股骨头坏死、股骨干骨折和踝关节扭伤,5例患者红细胞沉降率均增快、C反应蛋白增高,经X线、CT、MRI检查诊断为骨转移瘤。进一步完善了骨转移瘤的红色预警症状,如年龄>50岁,有肿瘤病史,不能解释的体质量减轻,全身不适,无明显诱因的颈肩腰腿痛,疼痛突然加重,夜间痛、静息痛、叩击痛明显,对症治疗1个月后无明显好转,病情发展不符合疾病一般规律,红细胞沉降率、C反应蛋白和碱性磷酸酶与疾病不相符升高,轻微外力产生骨折。结论根据红色预警症状进一步选择检验和影像检查,建立和完善适用于全科医生的恶性骨肿瘤临床路径,可简便、经济、有效地甄别恶性骨肿瘤。Objective To investigate the cause of misdiagnosis of neck,shoulder,waist,and leg pain caused by bone metastases and to improve the outpatient diagnosis rate.Methods Five misdiagnosed cases of bone metastases who were admitted to the Traditional Chinese Medicine Department of Orthopedics and Traumatology,School of Traditional Chinese Medicine,Southern Medical University from January 2019 to July 2020 were included in this study.Their clinical manifestations,diagnosis results(outside hospital diagnosis and outpatient diagnosis),and imaging manifestations were retrospectively analyzed.Results Five cases of bone metastases were misdiagnosed to have cervical spondylosis,lumbar disc herniation,femoral head necrosis,femoral shaft fracture,and ankle sprain.Accelerated red blood cell sedimentation rate and increased C-reactive protein level were found in all five cases.Bone metastases were confirmed by X-ray,CT,and MRI examination results.All of them had warning signs for bone metastasis:age>50 years,history of a tumor,unexplained weight loss,general malaise,neck,shoulder,waist,and leg pain without an obvious cause,sudden worsening of pain,night pain,resting pain,pain on direct palpation,no obvious improvements in these symptoms after symptomatic treatment for 1 month,disease development not conforming to the general law of cervical spondylosis,lumbar disc herniation,femoral head necrosis,femoral shaft fracture,and ankle sprain,increases in red blood cell sedimentation rate,C-reactive protein,and alkaline phosphatase levels,which are not consistent with the symptoms of cervical spondylosis,lumbar disc herniation,femoral head necrosis,femoral shaft fracture,and ankle sprain,and slight external force leading to fractures.Conclusion Further tests and imaging examinations should be performed according to warning signs.Clinical schemes of malignant bone tumors suitable for general practitioners can easily,economically,and effectively identify malignant bone tumors.

关 键 词：骨肿瘤 肿瘤转移 颈痛 肩痛 腰腿痛 X线 误诊 C反应蛋白质 血沉 

分 类 号：R738.1[医药卫生—肿瘤]