Etiology and clinical course of missed spine fractures.
Etiology and clinical course of missed spine fractures.
复制标题
漏诊脊柱骨折的病因和临床过程。
DOI：
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发表时间：
1987
期刊：
影响因子：
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通讯作者：
J. Miller
中科院分区：
文献类型：
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作者：
D. Reid;R. Henderson;L. Saboe;J. Miller
设计了一项前瞻性研究来记录过程和结果。回顾了253例患者的274处脊柱损伤，包括受伤和出院时以及受伤后1年、2年和5年的情况。这些患者中有38人在初步评估时被误诊。骨折位置、损伤原因、神经功能缺损和诊断延迟均记录在案：22.9%的颈椎损伤和4.9%的胸腰椎损伤的诊断延迟时间从不到1天到36天不等。延迟诊断的原因是：1）未能拍摄X线片，2）X线片漏诊骨折，3）患者未能就医。相关因素，如中毒的病人，多处受伤，意识水平，或两个层次的脊髓损伤有助于延迟诊断这些损伤。某些“高危”人群已被确定为错过脊柱损伤。尽管诊断延迟，但在我们的研究中似乎没有发生已确定的神经功能缺损的进展。然而，在延迟诊断组中，继发性缺陷的发展是显著的。
A prospective study was designed to document course and outcome. Two hundred fifty-three patients with 274 spinal injuries were reviewed at the time of injury and discharge from hospital, as well as at 1, 2, and 5 years postinjury. Thirty-eight of these patients were identified who had been misdiagnosed at the initial assessment. Fracture location, cause of injury, neurologic deficit, and delay in diagnosis were all documented: 22.9% of cervical injuries, and 4.9% of the thoracolumbar injuries had a delayed diagnosis ranging from less than 1 day to 36 days. The causes of delayed diagnosis were: 1) failure to take X-rays, 2) fractures missed on X-ray, and 3) failure of patients to seek medical attention. Associated factors such as intoxication of the patient, multiple injuries, level of consciousness, or two levels of spinal injury contributed to the delayed diagnosis of these injuries. Certain "at-risk" populations for missed spinal injuries have been identified. In spite of delays in diagnosis, progression of an established neurologic deficit did not appear to occur in our study. However, the development of secondary deficits was significant in the delayed diagnosis group.