弥漫性特发性骨肥厚相关脊柱骨折延迟诊断的危险因素：一项全国多机构调查。
Risk factors for delayed diagnosis of spinal fracture associated with diffuse idiopathic skeletal hyperostosis: A nationwide multiinstitution survey.
机构信息
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Aichi, Japan; Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan.
Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan.
出版信息
J Orthop Sci. 2021 Nov;26(6):968-973. doi: 10.1016/j.jos.2020.10.019. Epub 2020 Dec 15.
BACKGROUND
Patients with DISH are susceptible to spinal fractures and subsequent neurological impairment, including after minor trauma. However, DISH is often asymptomatic and fractures may have minimal symptoms, which may lead to delayed diagnosis. The purpose of this study was to identify risk factors for delayed diagnosis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis (DISH).
METHODS
The subjects were 285 patients with DISH surgically treated at 18 medical centers from 2005 to 2015. Cause of injury, imaging findings, neurological status at the times of injury and first hospital examination, and the time from injury to diagnosis were recorded. A delayed diagnosis was defined as that made >24 h after injury.
RESULTS
Main causes of injury were minor trauma due to a fall from a standing or sitting position (51%) and high-energy trauma due to a fall from a high place (29%) or a traffic accident (12%). Delayed diagnosis occurred in 115 patients (40%; 35 females, 80 males; mean age 76.0 ± 10.4 years), while 170 (60%; 29 females, 141 males; mean age 74.6 ± 12.8 years) had early diagnosis. Delayed group had a significantly higher rate of minor trauma (n = 73, 63% vs. n = 73, 43%), significantly more Frankel grade E (intact neurological status) cases at the time of injury (n = 79, 69% vs. n = 73, 43%), and greater deterioration of Frankel grade from injury to diagnosis (34% vs. 8%, p < 0.01). In multivariate analysis, a minor trauma fall (OR 2.08; P < 0.05) and Frankel grade E at the time of injury (OR 2.29; P < 0.01) were significantly associated with delayed diagnosis.
CONCLUSION
In patients with DISH, it is important to keep in mind the possibility of spinal fracture, even in a situation in which patient sustained only minor trauma and shows no neurological deficit. This is because delayed diagnosis of spinal fracture can cause subsequent neurological deterioration.
背景
患有 DISH 的患者易发生脊柱骨折和随后的神经损伤，包括轻微创伤后。然而，DISH 通常无症状，骨折可能症状轻微，这可能导致诊断延迟。本研究的目的是确定弥漫性特发性骨肥厚症（DISH）患者脊柱骨折延迟诊断的危险因素。
方法
本研究纳入了 2005 年至 2015 年期间在 18 个医疗中心接受手术治疗的 285 名 DISH 患者。记录了损伤原因、影像学表现、受伤时和首次就诊时的神经状态以及从受伤到诊断的时间。将延迟诊断定义为伤后>24 小时做出的诊断。
结果
主要损伤原因是因站立或坐姿摔倒引起的轻微创伤（51%）和因从高处坠落或交通事故引起的高能量创伤（29%）。115 例患者（40%；35 名女性，80 名男性；平均年龄 76.0±10.4 岁）发生了延迟诊断，而 170 例患者（60%；29 名女性，141 名男性；平均年龄 74.6±12.8 岁）进行了早期诊断。延迟组有更高的轻微创伤发生率（n=73，63% vs. n=73，43%），受伤时 Frankel 分级 E 级（完整的神经状态）的病例显著更多（n=79，69% vs. n=73，43%），且从受伤到诊断时 Frankel 分级恶化程度更大（34% vs. 8%，p<0.01）。多因素分析显示，轻微创伤摔倒（OR 2.08；P<0.05）和受伤时 Frankel 分级 E（OR 2.29；P<0.01）与延迟诊断显著相关。
结论
对于患有 DISH 的患者，即使患者仅遭受轻微创伤且无神经缺损，也应注意脊柱骨折的可能性。这是因为脊柱骨折的延迟诊断可能导致随后的神经恶化。
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