CAJ | 학술논문

目的试分析常规X线胸像椎体压缩骨折诊断忽视的原因.方法回顾分析1638例住院治疗患者的X线胸正侧位影像.年龄范围从50～91岁,平均(64±9)岁,其中男871例,女767例.所有患者的主诉或申请X线胸像检查的原因均与骨质疏松症和骨折无关.椎体压缩及分度的判定及分度方法选用Genant半定量(semiquantitative)目测法,椎体压缩骨折Ⅰ、Ⅱ、Ⅲ度的标准分别为椎体高度约减低20%～25%(Ⅰ度)、26%～40%(Ⅱ度)及41%以上(Ⅲ度),将椎体压缩骨折的影像评阅的结果与其既往X线报告结果和相应出院后病历记录进行比较分析.结果 1638例胸侧位影像评阅结果显示,椎体压缩骨折患者84例,压缩骨折的椎体总数为100个,其中X线影像报告已诊断为压缩骨折者共30例,X线影像报告未诊断的患者有54例.30例已诊断为椎体压缩骨折的X线影像报告中均未进行椎体压缩骨折的分度诊断.54例患者X线报告未诊断椎体压缩骨折63个,其中单发椎体压缩骨折47个,占X线报告未诊断椎体压缩骨折的75%;X线报告未诊断的Ⅰ度椎体压缩骨折34个(54%),Ⅱ度骨折21个(33%),而Ⅲ度骨折仅8个(13%).84例椎体压缩骨折患者中,行双能X线骨密度测量者仅有5例(6%),出院诊断椎体压缩骨折者仅有5例(6%),而出院带治疗骨质疏松症药物者也仅有15例(18%).15例带药患者所带与骨质疏松症治疗有关的药物均为钙类制剂.结论无论影像科还是其他科室的医师均应增强对骨质疏松症的全面认识,对患者X线胸像侧位片所示的椎体骨质疏松性压缩骨折应做出及时、完整的影像诊断,并予规范化的防治和干预.
목적 시분석상규X선흉상추체압축골절진단홀시적원인.방법 회고분석1638례주원치료환자적X선흉정측위영상.년령범위종50～91세,평균(64±9)세,기중남871례,녀767례.소유환자적주소혹신청X선흉상검사적원인균여골질소송증화골절무관.추체압축급분도적판정급분도방법선용Genant반정량(semiquantitative)목측법,추체압축골절Ⅰ、Ⅱ、Ⅲ도적표준분별위추체고도약감저20%～25%(Ⅰ도)、26%～40%(Ⅱ도)급41%이상(Ⅲ도),장추체압축골절적영상평열적결과여기기왕X선보고결과화상응출원후병력기록진행비교분석.결과 1638례흉측위영상평열결과현시,추체압축골절환자84례,압축골절적추체총수위100개,기중X선영상보고이진단위압축골절자공30례,X선영상보고미진단적환자유54례.30례이진단위추체압축골절적X선영상보고중균미진행추체압축골절적분도진단.54례환자X선보고미진단추체압축골절63개,기중단발추체압축골절47개,점X선보고미진단추체압축골절적75%;X선보고미진단적Ⅰ도추체압축골절34개(54%),Ⅱ도골절21개(33%),이Ⅲ도골절부8개(13%).84례추체압축골절환자중,행쌍능X선골밀도측량자부유5례(6%),출원진단추체압축골절자부유5례(6%),이출원대치료골질소송증약물자야부유15례(18%).15례대약환자소대여골질소송증치료유관적약물균위개류제제.결론 무론영상과환시기타과실적의사균응증강대골질소송증적전면인식,대환자X선흉상측위편소시적추체골질소송성압축골절응주출급시、완정적영상진단,병여규범화적방치화간예.
Objective To analyze the cause of missing diagnosis for vertebral fracture on lateral chest radiography. Methods Lateral chest radiographies of 1638 hospitalized patients (871 males and 767 females) were retrospectively reviewed for identifying vertebral fractures. Their ages ranged from 50 to 91 years with the mean of 63.5 years. Complains and application for chest radiography in all patients were not related to osteoporosis and vertebral fracture. Vertebral fracture and fracture severity were evaluated using Genant's semiquantitative visual method, taking approximately a 20%-25% vertebral height reduction as mild grade,26%-40% as moderate grade and 41% or greater as severe grade. Evaluation results of the vertebral fracture, original X-ray reports, as well as medical records were compared for further analysis. Results Eighty-four in 1638 patients showed vertebral fractures on the lateral chest radiographies. Of them,vertebral fractures were reported in 30 cases and 54 patients were not reported on their original X-ray reports. There were 63 vertebral fractures in 54 un-reported patients, most of which were single fracture (75% or 47/63). Grade Ⅰ fracture accounted for 54% (34/63), Grade Ⅱ fracture 33% (21/63), while 13% presented grade Ⅲ fracture (8/63). In all 84 patients with vertebral fractures, only 5 cases (6%)underwent dual energy X-ray absorptiometry (DXA) measurement, 5 cases ( 6% ) were recorded to have vertebral fractures on the medical papers, as well as 15 cases ( 18% ) were prescribed drugs related to the osteoporosis when discharged from hospital All drugs prescribed for the 15 patients were limited only to calcium. Conclusions More attention should be paid to osteoporosis by doctors including radiologists.Vertebral fracture on lateral chest radiography should be completely diagnosed, which is helpful for both prevention and treatment.