强直性脊柱炎脊柱骨折的延误诊断

Delayed diagnosis of spine fractures in ankylosing spondylitis

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 63 573 例，其中最终确诊脊柱骨折 3 363 例，占 5.29%。脊柱骨折的 3 363 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。

Abstract:

[Objective] To explore the cause of delayed diagnosis of spinal fractures in ankylosing spondylitis (AS) . [Methods] The pa- tients 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. [Results] From 2008 to 2019, a total of 63 573 patients with spinal diseases were admitted to our department, and among them 3 363 patients (5.29%) were finally diagnosed with spinal fractures. Of the 3 363 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 diagno- sis, 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 sig- nificantly 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 presenta- tion are also common reasons for initial misdiagnosis.