腕舟状骨骨折漏诊的原因分析及防范措施

目的：回顾性分析腕舟状骨骨折的疗效,探讨其漏诊原因及防范措施。方法：2007年9月至2010年9月,采用石膏固定和加压螺钉固定两种方法治疗腕舟状骨骨折16例,其中男10例,女6例;年龄26～44岁,平均35岁。12例患者外伤后腕桡侧肿痛,鼻烟壶处肿胀压痛,背伸腕关节时疼痛加重,被动伸拇、食指时疼痛加重,4例患者无明显症状,腕关节活动时无明显受限。9例早期诊断明确者,5例采用石膏固定,4例采用加压螺钉内固定治疗。7例漏诊中有4例症状体征不明显,初期先消肿活血止痛处理。其中4例采用石膏固定,3例采用加压螺钉内固定治疗。结果：16例均获随访,时间3～39个月,平均21个月。16例患者中早期确诊9例,漏诊7例,漏诊率为43.8%。采用加压螺钉内固定的7例,切口均无感染。石膏固定和加压螺钉固定各有1例出现疼痛和腕关节活动度下降,均发生在漏诊病例中,根据疗效评分标准此2例患者结果均为中,余14例为优。结论：腕舟状骨骨折临床上容易漏诊,早期诊断和治疗尤为重要。早期症状不明显、合并其他损伤、缺乏对此病的认识、忽视进一步检查是导致临床漏诊的主要原因。详细地询问病史及特殊体检、多方位摄片、及时进行CT或MRI是防范的主要措施。

The causes and preventive methods of misdiagnosis on wrist scaphoid bone fracture

Objective: To retrospectively analysis the curative effect of wrist scaphoid bone fracture,and explore the causes and preventive methods of misdiagnosis.Methods: From September 2007 to September 2010,16 patients with wrist scaphoid bone fractures were treated with plaster cast and cannulated screws fixation.There were 10 males and 6 females,ranging in age from 26 to 44 years with an average of 35 years.Among them,12 cases manifested swelling pain of radial lateral wrist,tenderness at snuffbox area,wrist pain aggravated when stretching wrist joint,thumb or forefinger;4 cases manifested no obviously symptoms and limited movement;9 cases were early diagnosed;5 cases were treated by plaster cast;4 cases were treated with cannulated screws fixation;Among 7 cases with misdiagnosis,there were 4 cases without obvious symptoms and they were dealt with activating blood to dissipate swelling and pain process in preliminary stage.Four cases were treated with plaster cast and 3 cases with cannulated screws fixation.Results: All the patients were followed up from 3 months to 39 months(averaged 21 months).Among 16 patients,9 cases were early diagnosis,7 cases were misdiagnosis and the rate of misdiagnosis was 43.8%.Seven cases with screws fixation were no wound infection.There was 1 case with occurred chronic pain and declining wrist mobility in both plaster cast and screw group,and both of them were misdiagnosed.According to curative effect rating criteria,these 2 cases were classified into moderate,other 14 cases were excellent.Conclusion: Wrist scaphoid bone fracture are easy to misdiagnose,so early diagnosis and treatment is particularly important.The main causes of misdiagnosis are nonspecific symptoms at early stage,combination with other injuries,lack of knowledge and ignorance of the further examination.Therefore,detailed inquiries and particular examination,multi-dimensional radiography and CT scan or MRI scan are the main measures for prevention.