摘要
目的探讨隐匿性股骨颈骨折的误漏诊原因并提出防范措施。方法回顾性分析2010年2月—2015年7月沧州市中心医院收治的曾误漏诊的隐匿性股骨颈骨折12例的临床资料,并复习相关文献。结果本组就诊时8例诉髋部疼痛明显,2例髋部无明显疼痛,2例合并颅脑损伤出现意识障碍导致昏迷。合并颅脑损伤2例,合并同侧股骨干中段骨折3例。骨盆X线检查均无明显骨折征象。首诊皆未考虑股骨颈骨折,合并颅脑损伤致昏迷2例仅诊断颅脑损伤,合并同侧股骨干中段骨折3例仅诊断股骨干中段骨折,余7例均误诊为患肢软组织损伤。本组误漏诊时间2 d^1.5个月。12例均于再次或复诊时问诊和查体发现患髋疼痛加重,经X线和(或)CT、MRI检查确诊股骨颈骨折。11例给予闭合复位并AO空心钉固定手术治疗,1例行人工股骨头置换术。12例术后均愈合良好出院。结论隐匿性股骨颈骨折极易误漏诊。临床上对高度怀疑隐匿性股骨颈骨折,而X线检查阴性者应进一步行CT或MRI检查,或建议短期内复查X线,以减少或避免隐匿性股骨颈骨折误漏诊。
Objective To investigate missed diagnosis and misdiagnosed causes of occult femoral neck fracture and to provide preventive measures.Methods Clinical data of 12 missed diagnosis or misdiagnosed patients with occult femoral neck fracture admitted during February 2010 and July 2015 was retrospectively analyzed, and relevant literature was reviewed.Results In the 12 patients, 8 patients complained hip pain obviously, and 2 patients had no obviously hip pain, and 2 patients had coma induced by disturbance of consciousness because of combination of craniocerebral injury.There were 2 patients combined with craniocerebral injury and 3 patients combined with ipsilateral femoral midpiece fracture.No obvious fracture was found by pelvis pa X-ray examination.All patients were not diagnosed as having femoral neck fracture by primary diagnosis, The 2 patients, who had coma induced by disturbance of consciousness because of combination of craniocerebral injury, were only diagnosed as having craniocerebral injury;3 patients, who had combined with ipsilateral femoral midpiece fracture, were only diagnosed as having femoral midpiece fracture;other 7 patients were misdiagnosed as having soft tissue injuries of affected limb.The missed diagnosis and misdiagnosed time was 2 d-1.5 months.All the 12 patients were found aggravated pain in affected hip during revisiting or inquisition, and femoral neck fracture was confirmed by X-ray and （or） CT MRI examinations.Closed reset combined with AO hollow nail fixation was performed in 11 patients, and artificial femoral head replacement was performed for other 1 patient.All the patients were discharged after postoperatively healing well.Conclusion Occult femoral neck fracture is easily missed diagnosis or misdiagnosed.Clinicians should take further CT or MRI examinations or suggest rechecking in short term for patients with negative results of X-ray test in order to avoid missed diagnosis or misdiagnosis.
出处
《临床误诊误治》
2017年第8期28-30,共3页
Clinical Misdiagnosis & Mistherapy
关键词
股骨颈骨折
误诊
漏诊
软组织伤
Femoral neck fracture
Misdiagnosis
Missed diagnosis
Soft tissues injuries
