摘要
目的探讨寰枢关节半脱位的临床特点、误诊原因,并总结防范误诊措施。方法对2022年1月至2023年3月收治的曾误诊的10例寰枢关节半脱位的临床资料进行回顾性分析。结果10例分别因颈部疼痛、上肢放射性疼痛麻木、头痛、头晕、耳鸣等原因就诊,行颈椎MRI、头颅CT、经颅多普勒超声、纯音听阈测试等检查后,4例误诊为神经根型颈椎病,3例误诊为颈源性头痛,3例误诊为梅尼埃病。误诊时间7~14d。10例均经颈椎X线侧位及齿突张口位检查确诊为寰枢关节半脱位,予间歇式牵引、手法整复治疗,治疗后随访3个月,上述症状均缓解或消失,无复发。结论寰枢关节半脱位临床表现复杂多样且无特异性,容易误诊;临床医生应加强对本病的认识,全面分析病情,详细问诊查体,合理选择检查项目,认真鉴别诊断,以减少或避免误诊的发生。
Objective To investigate the clinical characteristics and causes of misdiagnosis of atlantoaxial subluxation(AAS),and to summarize preventive measures.Methods The clinical data of 10 patients with AAS misdiagnosed and then treated from January 2022 to March 2023 were retrospectively analyzed.Results Ten patients presented with neck pain,upper limb radia-tion pain and numbness,headache,dizziness,and tinnitus.After cervical MRI,head CT,transcranial Doppler ultr sound(TCD),pure tone threshold test and other examinations,4 patients were misdiagnosed with cervical radiculopathy,3 patients with cervical headache,and 3 patients with Meniere's disease.Misdiagnosis lasted from 7 to 14 d.All the 10 patients were diagnosed with AAS by cervical X-ray and examination using open-mouth view of the odontoid,and were treated with intermittent traction and manual reconstruction.At 3 months after treatment,the above symptoms were relieved or disappeared without recurrence.Conclusion The clinical manifestations of AAS are complex and non-specific,and it is more likely to be misdiagnosed.For clinicians,strengthening the understanding of the disease,comprehensive analysis of the condition,detailed examination,reasonable selection of examination items,and careful differential diagnosis are needed in order to reduce or avoid the occurrence of misdiag-nosis.
作者
李德成
任彦景
赵广义
王芳芳
张彦敏
高冕
牛苗苗
LI Decheng;REN Yanjing;ZHAO Guangyi;WANG Fangfang;ZHANG Yanmin;GAO Mian;NIU Miaomiao(Department of Rehabilitation Medicine,the 98Oth Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army,Shijiazhuang 050082,China;Department of Orthopaedics,the 98Oth Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army,Shijiazhuang 050082,China;Department of Health Medicine,the 98Oth Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army,Shijiazhuang 050082,China)
出处
《临床误诊误治》
CAS
2024年第11期6-9,33,共5页
Clinical Misdiagnosis & Mistherapy
基金
河北省中医药管理局科研计划项目(2022448)。
关键词
寰枢关节半脱位
误诊
神经根型颈椎病
颈源性头痛
梅尼埃病
X线检查
鉴别诊断
Atlantoaxial subluxation
Misdiagnosis
Cervical radiculopathy
Cervicogenic headache
Meniere's disease
X-ray examination
Differential diagnosis
