肋骨骨折合并肩锁关节脱位的漏诊分析
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李家威,闫雪松 ,范志鹏,吴卓航,张贵春
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1.中国人民解放军联勤保障部队第九六〇医院骨科,山东济南,250031；2.山东第一医科大学临床医学院，山东济南 250117；3.山东第二医科大学临床医学院,山东潍坊,261000
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摘要 : 目的? 探究如何有效诊断肋骨骨折合并肩锁关节脱位，从而减少漏诊率。方法? 采用回顾性病例对照研究分析中国人民解放军联勤保障部队第九六〇医院 2014年 6月 1日至 2024年 4月 26日收治的符合纳入标准的 163例肋骨骨折合并肩锁关节脱位的患者，其中有 73例患者行胸部正位X线片检查，有 48例患者行胸部CT检查，有 42例患者行双肩站立应力位X线检查，统计三组患者的漏诊情况，采用卡方检验分析三组患者漏诊情况有无统计学意义。结果? 三组患者漏诊率差异显著（P=0.001）。进一步两两比较显示，胸部正位X线片与胸部CT组（P ＜ 0.05）、胸部正位 X线片与双肩站立应力位 X线组（P=0.001），以及胸部 CT与双肩站立应力位 X线组（P<0.05）之间，漏诊率均有统计学意义。结论? 对于肋骨骨折患者，肩锁关节容易合并损伤，临床上有一定的漏诊率，采用仔细询问病史，详细查体，双肩站立应力位X线、双肩CT扫描+三维重建及MRI成像技术等可减少肩锁关节脱位的漏诊率。
关健词：肋骨；骨折；肩锁关节；脱位；漏诊；疗效 |
Analysis of Missed Diagnosis in Rib Fractures Combined with Acromioclavicular Joint Dislocation
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Jiawei Li, Xuesong Yan, Zhipeng Fan
, Zhuohang Wu
, Guichun Zhang
1.Department of Orthopaedics, The 960th Hospital of the PLA Joint Logistics Support Force,
Jinan Shandong 250031, China; 2.Medical School of Clinical Medicine of Shandong First Medical University, Jinan Shandong 250117, China; 3.Medical School of Clinical Medicine of Shandong Second Medical University, Weifang Shandong 261000, China
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Abstract：Objective To explore how to effectively diagnose rib fractures combined with acromioclavicular joint dislocation, thereby reducing the missed diagnosis rate. Methods A retrospective case-control study was conducted to analyze 163 patients with rib fractures combined with acromioclavicular joint dislocation who met the inclusion criteria and were admitted to the 960th Hospital of the PLA Joint Logistics Support Force from June 1, 2014 to April 26, 2024. Among them, 73 patients underwent chest posteroanteri
or X-ray examination, 48 patients underwent chest CT examination, and 42 patients underwent bilateral shoulder standing stress X-ray examination. The missed diagnosis situations of the three groups were statistically analyzed using chi-square test. Results There were significant differences in the missed diagnosis rates among the three groups (P=0.001). Further pairwise comparisons showed that there were statistically significant differences in missed diagnosis rates between chest posteroanterior X-ray and chest CT groups (P＜0.05), between chest posteroanterior X-ray and bilateral shoulder standing stress X-ray groups (P=0.001), and between chest CT and bilateral shoulder standing stress X-ray groups (P<0.05). Conclusion For patients with rib fractures, the acromioclavicular joint is prone to combined injuries, and there is a certain rate of missed diagnosis clinically. Careful inquiry of medical history, detailed physical examination, bilateral shoulder standing stress X-ray, bilateral shoulder CT scan with three-dimensional reconstruction, and MRI imaging technology can reduce the missed diagnosis rate of acromioclavicular joint dislocation.
Keywords : Rib; Fracture; Acromioclavicular joint; Dislocation; Missed diagnosis; Therapeutic effect
参考文献
[1] 孔令文，黄光斌，易云峰,等.创伤性肋骨骨折手术治疗中国专家共识（2021 版）. 中华创伤杂志，2021，37(10):865-875.
[2] 徐志飞，孙居仙.肋骨骨折的诊疗进展.中华创伤杂志，2010，26(06):481-484.
[3] Flores D V , Goes P K ,Catalina Mejía Gómez,et al.Imaging of the Acromioclavicular Joint: Anatomy, Function,Pathologic Features, and Treatment[J].Radiographics,2020, 40(5):200039.
[4] Mannan M , Afridi A , Ahmed K T ,et al.Functional Outcomes of the Management of Acromioclavicular JointDislocation With a Clavicle Hook Plate: A RetrospectiveStudy[J].Cureus, 2024.
[5] 范俊 .X 线、CT 及 MR 三种影像诊断技术对肩锁关节脱位诊断价值研究 [J]. 影像研究与医学应用 ,2022,6(03):116-118.
[6] Perry N P J , Omonullaeva N K , Bacevich B M ,et al.Acromioclavicular Joint Anatomy and Biomechanics: TheSignificance of Posterior Rotational and Translational Stability[J].Clinics in Sports Medicine, 2023, 42(4):15.
[7] 韩强 . 探讨 X 线、C T 及 M R 三种影像诊断技术对肩锁关节脱位的诊断价值 [J]. 影像研究与医学应用,2021,5(11):123-124.
[8] 陈维聪.改良肩锁关节X线轴位投照技术的临床应用研究[J].影像研究与医学应用,2022,6(01):70-72.
[9] 张磊 , 王振海 , 王丹 . 锁骨骨折合并肩锁关节脱位及喙突骨折漏诊1例反思[J].实用手外科杂志,2021,35(03):377-378.
[10] 韩梦杨.改良肩关节X线摄影方法与常规方法的对照研究[J].实用放射学杂志，2018，34(4):603-605.
[11] 李斌 , 朱爱国 , 曹东兴 , 等 . 对比分析 3D CT 及 X 线片对肩关节损伤的诊断价值 [J]. 中国老年学杂志,2022,42(08):1921-1923.
[12] Yoon Y S, Cha J G. MRI findings of periarticular lesionswith isolated greater tubercle fractures and dislocation[J]. Current Medical Imaging Reviews, 2023, 19(12):1476-1486. |
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