老年股骨颈骨折X线漏诊原因分析及预防措施

目的分析探讨老年股骨颈骨折的漏诊原因及预防措施。方法我院2007年1月～2011年12月134例老年性股骨颈骨折患者进行X线检查，发生漏诊9例，漏诊率6．7％。漏诊患者年龄在62～83岁，平均年龄72．3岁。其中2例患者首诊X线检查表现不明显，因症状加重两周后复查X线发现，6例进一步CT检查及重建获得股骨颈骨折清晰图像而确诊，1例行MRI检查发现细微骨折。结果9例股骨颈骨折X线检查漏诊患者均为GardenI型，属于稳定性骨折，其中7例属于外展嵌插型骨折，2例为不完全骨折。所有患者均经CT、MRI及临床复诊X线证实。从初诊到确诊7～30d，平均15d。结论老年股骨颈骨折表现隐匿，极易漏诊。提高业务水平，加强责任心，对年龄偏大、临床症状较重、有可疑征象者，建议随访复查或可进一步行髋关节CT扫描及重建以及MRI检查，方能减少漏诊发生。

The analysis and prevention measures of x-ray misdiagnosis causes on the old with femoral neck fracture

Objective To analyse and investigate the reasons for missed diagnosis of old man femoral neck fracture and preventive measures.Methods There were 134 Cases of femoral neck fracture patients with X-ray checking in our hospital between January,2007 to December,2011,total 9cases of that were missed diagnosis.The missed cases was 62-83 years old,average 72.3,2 one cases of that were not obvious in t X-ray checking last 2 weeks.6 cases diagnosed by further CT examination and reconstruction,1 occult fractures case diagnosed by MRI.Results The missed 9 cases were all the stability of fracture,belonging to Garden type I,in which,7 cases of embedded fracture type,2 cases of incomplete fracture.All cases verified by CT,MRI or X-ray re-checking.There was about 7-30 d from first checking to diagnosing,average 15d.Conclusion The old femoral neck fracture cases may be misdiagnosed for disguised performance.To improve diagnosis technology,strengthening the responsibility,suggesting the older,severe and suspicious cases to check with CT scan and MRI,which would reduce misdiagnosis.