X线平片肋骨骨折漏诊原因分析与对策

在胸部创伤中肋骨骨折最为常见，而X线平片是目前检查的前选方法，除了可以发现肋骨骨折外，尚可发现锁骨、肩胛骨等部位的骨折，以及是否合并气胸、液气胸、胸腔积液、肺挫伤、皮下纵膈积气等异常改变。但是，在实际工作中，由于种种原凶如外伤时骨折端无明屁锚位或骨折端有嵌入，造成有些肋骨骨折胸部X线平片很难发现，另外有些患者病情危重，甚至是在抢救过程中床边摄片，X线照片质量较差，造成误诊或漏诊．延误诊断，给病人造成痛苦或危及生命，有些给法医鉴定带来困难，甚至引起医疗纠纷。本人收集我院自2001年1月以来资料完整，胸部创伤中有肋骨骨折的患酱262例，并作回顾性分析，其中有38例x线平片首诊漏诊，现分析报告如下。     

急诊胸部X线平片诊断肋骨骨折漏诊误诊分析及对策

近年来,本院急诊外伤就诊的患者逐年增加,胸部外伤后的肋骨骨折也十分常见.使用胸部X线平片诊断肋骨骨折是最简便的手段,同时往往因为患者的病情和投照的技术原因,造成肋骨骨折的漏诊及误诊,给患者带来不必要的痛苦.在此收集外伤后有肋骨骨折的患者500例,其中出现46例少诊断肋骨骨折的漏诊及22例多诊断肋骨骨折的误诊进行分析,借此在临床工作中尽可能降低肋骨骨折的漏诊和误诊现象.     

肋骨骨折首次X线平片检查漏诊原因分析

在胸部创伤中肋骨骨折最为常见，X线平片是检查的首选方法，常因检查部位，投照体位或X线曝光条件选择不当而造成漏诊，给病人带来不必要的痛苦，甚至因延误诊断而危及生命，为此结合文献资料，分析漏诊的原因，来最大程度地提高X线平片对肋骨骨折的检出率。     

X线平片和CT扫描对胸部创伤的诊断价值

目的：探讨X线平片和CT对胸部创伤的临床诊断价值。方法：总结分析386例严重胸部创伤患者的影像检查,以临床诊断和影像复查为金标准,对X线平片与CT对胸部创伤的诊断价值进行对比分析。结果：386例中,胸壁骨折328例,气胸82例,血胸98例,血气胸136例,肺挫伤265例,肺撕裂伤150例,肺不张75例,支气管损伤11例,胸主动脉损伤8例,纵隔血肿9例,心包心脏损伤12例,膈肌损伤17例,创伤后呼吸窘迫综合症（ARDS）52例。X线平片分别漏诊22,22,20,22,133,72,36,4,6,9,11,17,28例,CT除17例肋骨骨折外均准确诊断。结论：X线和CT联合检查能够明确胸部创伤病变的部位、性质、程度,为临床提供可靠诊断,可监测病情演变,评价治疗效果。     

肋骨骨折首次-X线平片检查漏诊原因分析

目的：进一步提高肋骨骨折X线平片首次检出率。方法：对我院近年来428例肋骨骨折的病例进行回顾性分析。结果：428例肋骨骨折中，首次X线平片未发现肋骨骨折22例，占5．14％；多发性肋骨骨折的患者，误诊或漏诊发现部分肋骨骨折29例，占6．7％；两者共50例，占11．8％。首次X线平片检查未发现、误诊或漏诊肋骨骨折的病例，大部分为定位、选择检查部位不当；少部分则因病情重、投照体位及其它X线征象掩盖所致。结论：根据患者的症状，确定检查的部位，摆放适当的体位，选择合适的投照条件，可以将肋骨骨折的漏诊率减少到最低限度。     

肋骨骨折常见漏诊原因临床分析

肋骨骨折在胸部创伤中最为常见,X线平片是检查的首选方法,但是往往由于位置、方法、条件等原因,造成一些不必要的漏诊,给临床诊断及治疗带来了许多负面影响,甚至造成医疗纠纷的发生,所以,准确无误的诊断是十分必要的。为此,本文结合我院近年来首次X线平片漏诊的病例资料,分析漏诊原因并提出改进方法,以最大程度提高肋骨骨折的检出率。     

多层螺旋CT MIP、CPR重建在肋骨骨折医学鉴定的应用

肋骨骨折是胸部外伤中最为常见的损伤,也是医学鉴定的主要内容之一,肋骨骨折常规诊断依靠X线片, 但在骨折无移位或合并胸部其他损伤以及肋软骨骨折诊断方面,普通X线检查常不能明确诊断,以致造成漏诊,给医学鉴定带来困难.     

肋骨骨折较易漏误诊的原因探讨及对策

肋骨骨折的诊断在胸部外伤中经常遇到，对于有错位、皮质断裂、及骨折线的明显的骨折较易诊断，对于所谓的隐性骨折和骨折征象不明显或假象而造成漏诊、误诊，给临床诊治和患者带来不必要的麻烦。尽早正确地做出诊断，具有较为重要的现实意义。现将我院40例肋骨骨折的漏诊，误诊原因分析如下。     

多层螺旋CT三维重建在胸部外伤骨折中的应用价值

目的：探讨多层螺旋CT三维重建在胸部外伤骨折中的应用价值。方法：分析30例胸部外伤骨折的病例,全部病例均行X线检查、多层螺旋CT扫描与三维重建容积再现法（VR）、多平面重建（MPR）,观察和分析骨折的位置、数量及邻近组织、脏器的情况。结果：30例胸部外伤病例,MSCT检查共发现肋骨骨折19例（50处）,肋软骨骨折3例（7处）,胸骨骨折12例（14处）,肩胛骨骨折7例（10处）。轴位图像、MPR重建能清晰地显示出骨折及断端移位情况,结合VR重建,肋骨骨折的位置、数目的显示均较确切;另外还发现肺挫伤13例,血胸20例,气胸7例;肝脏、脾脏挫裂伤各1例;胸骨骨折合并胸骨旁、前纵隔血肿8例。X线平片共发现肋骨骨折35处、肋软骨骨折0处、胸骨骨折1处、肩胛骨骨折6处;x线平片仅发现肺挫伤5例,血气胸10例;X线平片和MSCT同时发现锁骨骨折2处、胸椎骨折2处。结论：多层螺旋CT轴位图像、MPR及VR三维重建的联合应用,对判断胸部外伤骨折及邻近组织、脏器损伤有很高的诊断价值,明显优于常规X线检查,尤其对临床可疑肋骨骨折及肋软骨、胸骨骨折是一种重要的补充检查手段。     

146例胸部创伤的X线平片与CT检查的对比分析

目的探讨X线平片在胸部创伤中的地位。方法对我院1995～1998年因胸部创伤采用X线平片和CT检查的146例进行对照分析。结果肋骨骨折104例,X线平片发现99例、CT发现101例、共同发现96例占92.31%;肺挫伤73例,X线平片发现46例、CT发现71例,液气胸57例,X线平片发现47例、CT发现56例。结论X线平片仍应是胸外伤首诊的主要检查方法,简便、快捷、经济、准确。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.