隐匿骨折的影像诊断.docVIP

隐匿骨折的影像诊断 龙昌平 626000 四川，甘孜州人民医院放射科 　　【摘要】 目的 探讨准确诊断隐匿骨折，减少其误漏诊的方法。从而避免因误漏诊隐匿骨折而引起的医患纠纷。方法 对我院2007~2008年42例隐匿骨折患者进行回顾分析，用常规DR对患者进行的正侧位摄影结合正、斜、切线位双能量减影和CT、MRI检查。结果 首次常规DR正侧位摄影，提示诊断的5例，怀疑诊断的9例，其中次日或第3日用双能量减影复查明确诊断6例;做CT明确诊断16例;做MRI明确诊断5例;因临床症状不消，1周后来复查DR明确诊断的7例，此7例均调阅当时的DR或CT片，发现7例中除有1例是当时误漏诊外，其余6例当时照片确实无骨折征象显示，将其称为暂不显示性隐匿骨折。这6例暂不显示性隐匿骨折中有4例会诊报告示1周后复查，有2例无此复查提示，引起了医患纠纷。结论 结合临床诊断隐匿骨折非常重要，采取多体位摄像，多种检查手段诊断，对仍然难免的误漏诊暂不显示性隐匿骨折，会诊报告上一定要提示复查。 　　【关键词】 隐匿骨折;多种方法检查;误漏诊;医患纠纷;复查 　　Imaging diagnosis on occult fracture 　　LONG Chang-ping.Department of Radiology,Ganzi Peoples Hospital,Ganzi 626000,China 　　[Abstract] Objective Trying to find an accurate diagnosis of occult fracture，to reduce the error of their ways of missed diagnosis.In order to avoid missed diagnosis of occult fracture in patient disputes arising from the occurrence.Methods On 2007~2008，42 cases of occult fracture patients were retrospectively analyzed，DR of conventional patients is combined with photography in lateral，oblique，tangent-bit dual-energy subtraction and CT，MRI examination.Results DR is the first time，conventional lateral photography，prompt diagnosis were 15 cases;27 cases were suspected diagnosis;On next day or 3rd day used dual-energy subtraction to review clear diagnosis of 6 cases;CT for a clear diagnosis of 24 cases;Directly to other hospital for MRI diagnosis were 5 cases(be cause of without equipment); As a result of clinical course;a week later reviewed DR clear diagnosis of 7 cases，7 cases were available at the time of the DR or CT films to review.In the 7 cases found 1 case there was missed，the other 6 cases at the time of photos did not show signs of fracture，then called it hidden fractures.6 cases of hidden fractures，4 cases had rechenck request，2 cases were not，then caused a dispute between doctors and patients.Conclusion Clinical diagnosis of occult fracture is very important，multi-camera position，a variety of means to check the diagnosis，the inevitable mistake not to show missed diagnosis