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股骨远端疲劳骨折误诊教训 |
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秦国斌 韦自修
【摘要】 目的 提高对疲劳骨折的认识和诊断水平,避免误诊误治。 方法 报告和总结5例股骨远端疲劳骨折的诊治经验和误诊教训。 结果 5例患者均为男性,年龄18~23岁,病程3~6周,均有高强度运动史。经X线片检查及病理活检,初步诊断为骨肉瘤;后经仔细询问并分析病史,结合系列X线片观察,诊断为股骨远端疲劳骨折。经患肢适当制动和对症治疗,患者症状逐渐减轻或消失,均痊愈出院。随访7~18个月,患者无异常。结论 仔细询问病史,熟悉并掌握骨折愈合各阶段的形态学特征,以及正确的病理诊断,是避免误诊误治的关键。 【关键词】 骨折,应力性 股骨 骨肉瘤 诊断,鉴别
Misdiagnosis of tired fracture of distal segment of femur Qin Guobin,Wei Zixiu.Department of Orthopaedics,Anyang People′s Hospital,Anyang 455000. 【Abstract】 Objective To improve the diagnosis of tired fracture of the distal segment of femur,and to avoid its misdiagnosis.Method Misdiagnosis of 5 patients with tired fracture of distal segment of the femur was reviewed.Result Five male patients, aged 18 to 23 years had the lesion for 3 to 6 weeks.They had long tough experience of sports. The lesion was considered at first as osteosarcoma by radiograph and biopsy. It was eventually diagnosed as tired fracture of distal segment of the femur. Symptoms were redieved or disappeared after proper treatment. Follow-up for 7 to 18 months showed good results.Conclusion The key to avoid misdiagnosis and mistreatment of the fracture is to know its causes,morphological features of fracture healing, and correct pathologic diagnosis. 【Key words】 Fractures,stress Femur Osteosarcoma Diagnosis,differential
疲劳骨折亦即应力骨折,发生于股骨者非常少见。这种类型由于局部解剖关系、生物力线的垂直分布以及骨膜下新骨的产生,骨折段不会分离,而只形成一种肿块形改变。我们1985年~1994年收治5例。现将诊断和治疗的经验、教训报告如下。
临床资料
1.一般资料:本组5例均为男性学生,年龄17~23岁,病程3~6周,发病部位均为股骨下端,其中右侧4例,左侧1例。均有较长时间和高强度的下肢运动史。3例于剧烈活动后逐渐出现股骨下端疼痛,局部触摸有肿块。4例因外院诊断为骨肉瘤准备截肢,患者及家属不愿接受而转入我院,1例为我院门诊以“右股骨骨肉瘤”为初步诊断收入院。 2.典型病例:患者于入院前1个月无明显诱因出现右股骨下段持续性疼痛,劳累后加重,休息后减轻;局部轻度肿胀,可触及一个大小约10 cm×8 cm×6 cm的梭形肿块,质硬、无活动度,双下肢等长。X线片示右股骨中下段骨膜被掀起,下段可见皮质骨旁成骨性阴影,骨小梁排列不规则,密度增加(图1)。血液生化检查:碱性磷酸酶(AKP)230 U/L,血沉20 mm/h。骨穿刺活检病理报告为“见到骨母细胞的核分裂相并有新生骨”,考虑为“高分化骨肉瘤”,建议术中再做病理检查。临床诊断为“右股骨皮质旁骨肉瘤”,拟行[1] [2] 下一页 上一个医学论文: Colles骨折合并桡腕关节背侧半脱位临床诊断标准的探讨 下一个医学论文: 胫骨髁骨折的手术治疗
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