CAJ | 학술논문

目的：通过对多例骨科腰腿疼痛的典型误诊病例的误诊原因进行分析，探讨全科医学的临床思维。方法本研究选取了6例腰腿疼痛误诊误治患者，对其临床资料、诊治过程及误诊原因进行分析。结果6例患者的就诊原因均以腰部、下肢或腰腿疼痛为主，其中股骨头缺血性坏死误诊为腰椎间盘突出症2例，带状疱疹误诊为腰椎间盘突出症2例，阑尾脓肿误诊为腰椎间盘突出症1例，十二指肠溃疡误诊为腰背肌筋膜炎1例。结论腰部或腰腿疼痛的症状可由多种原因引起，临床医生在诊断过程中要注意将病史、症状、查体和实验室检查结合起来（四结合）。作为骨科专科医师，除了要不断学习、掌握和提高本专业的知识及技能外，还要培养全科医学的临床思维。
목적：통과대다례골과요퇴동통적전형오진병례적오진원인진행분석，탐토전과의학적림상사유。방법본연구선취료6례요퇴동통오진오치환자，대기림상자료、진치과정급오진원인진행분석。결과6례환자적취진원인균이요부、하지혹요퇴동통위주，기중고골두결혈성배사오진위요추간반돌출증2례，대상포진오진위요추간반돌출증2례，란미농종오진위요추간반돌출증1례，십이지장궤양오진위요배기근막염1례。결론요부혹요퇴동통적증상가유다충원인인기，림상의생재진단과정중요주의장병사、증상、사체화실험실검사결합기래（사결합）。작위골과전과의사，제료요불단학습、장악화제고본전업적지식급기능외，환요배양전과의학적림상사유。
Objective To investigate the clinical thinking of general practice by analyzing the reasons for misdiagnosis in several cases of loin and leg pain and to explore the clinical thinking of general practice. Methods We selected 6 cases of patients with loin and leg pain that were misdiagnosed,and their clinical data,process of diagnosis and treatment and the reasons for misdiagnosis were analyzed. Results The reasons for the 6 patients seeking for diagnosis in hospital were mainly pain in waist,pain in lower limb or loin and leg pain. Among them,2 patients with ischemic necrosis of femoral head were misdiagnosed as protrusion of lumbar intervertebral disc,2 patients with herpes zoster were misdiagnosed as protrusion of lumbar intervertebral disc,one patient with appendiceal abscess was misdiagnosed as protrusion of lumbar intervertebral disc,and one patient with duodenal ulcer was misdiagnosed as myofascitis of the back region. Conclusion Waist pain or loin and leg pain can be caused by many reasons. Clinical doctors should make diagnosis on the basis of medical history,symptoms,physical examination and laboratory examination results. Apart from learning constantly and improving the knowledge and skills of the discipline,doctors of orthopedics should also cultivate the clinical thinking of general practice.