垂直不稳定骨盆骨折延迟诊断原因分析

摘要

Objective :To explore the causes of delayed diagnosis of the vertical unstable pelvic fractures in patients with multiple trauma so in order to minimize these incidence. Methods:A retrospective study was conducted in 176 patients with the vertical unstable pelvic fractures from January 2003 to December 2008. The classification of vertical unstable pelvic fraetures was recorded. Medical data were compared and statistically analyzed to identify the incidence ,and the contributing factors of the delayed diagnosis of the vertical unstable pelvic fractures. Of the 176 patients,46 (26.1％) had delayed diagnosis of the vertical unstable pelvic fractures. There were 29 males and 17 females with an average age of 34 years old. Results:Of the factors contributing to 46 eases of delayed diagnosis,41.3％(19/46) closely related to the evaluation by the doctors and were potentially avoidable,and 58.7％ (27/46) were associated with the severity of the injuries. Conclusion:The patients with multiple trauma had high incidence of delayed diagnosis of the vertical unstable pelvic fractures. The recognition of pelvic fractures,careful clinical assessments,and the awareness of the orthopedic doctors,emergency doctors and ICU doctors. Most of the delayed diagnosis of the vertical unstable pelvic fractures in patients with multiple trauma are potentially avoidable.%目的:探讨垂直不稳定骨盆骨折延迟诊断的原因并作初步分析,以期降低垂直不稳定骨盆骨折延迟诊断的发生率.方法:对2003年1月至2008年12月收治176例垂直不稳定骨盆骨折患者进行回顾性分析,记录延迟诊断惠者骨盆骨折的类型,患者的确诊方法和时间;患者的伤情因素和医师主观因素与延迟诊断的关系,分析造成垂直不稳定骨盆骨折延迟诊断的原因.所有患者的诊断经2名副主任及以上职称医师确诊,最终46例患者符合延迟诊断标准,男29例,女17例,平均年龄34岁.结果:27例延迟诊断的因素主要与患者伤情有关,即客观因素,最常见客观因素是呼吸循环不稳定,占17例(17/46).19例延迟诊断的因素主要与临床医师评估有关,即主观因素,其中11例为专业骨科医生判断错误.结论:垂直不稳定骨盆骨折延迟诊断发生率在严重多发伤中较高,骨科、ICU和急诊科医生提高对该类损伤的认识水平和保持高度警惕性,可望极大程度地减少垂直不稳定骨盆骨折延迟诊断的发生率.