椎管硬膜下髓外肿瘤延迟诊断原因分析(1)
 |
| 第1页 |
参见附件(2163KB，3页)。
【摘要】目的探讨不同节段椎管硬膜下髓外肿瘤延迟诊断的原因。方法回顾分析了62例手术治疗的椎管硬膜下髓外肿瘤的临床资料。分析病理诊断、疾病的首发症状、MRI确诊时的症状、从首发症状到MRI确诊的时间间隔。结果颈椎管硬膜下髓外肿瘤最常见的首发症状是颈部疼痛或一侧上肢疼痛或麻木,分别占40%、55%;胸椎最常见的首发症状是下腰部疼痛或下肢麻木,分别占38%、50%,躯干疼痛或麻木的占16%。腰椎管硬膜下髓外肿瘤首发症状是下腰部疼痛或下肢麻木占87%。颈、胸、腰椎平均要延迟16.5、14.8、8.4个月才能确诊。结论颈椎椎管内肿瘤延迟诊断的主要原因是没有及时就诊;胸椎椎管内肿瘤最容易延迟诊断,原因是多数首发症状与腰椎退行性病变的表现类似,误认为是腰部病变选择了错误的检查部位。
【关键词】
椎管硬膜下髓外肿瘤; 诊断;MRI
Analysis of the causes of delay diagnosis in the intradural extramedullary neoplasms
JING Zhizhen,SONG Jiefu,HU Wei.Department of Orthopaedics,Shanxi Provincial People’ Hospital,Taiyuan 030012,China
【Abstract】ObjectiveTo investigate the reasons of delay diagnosis of the intradural extramedullary neoplasms.MethodsRetrospective analysis of 62 cases of the intradural extramedullary tumors was done.Records of patients were studied for initial symptoms,symptoms at diagnosis,and time interval between onset of the initial symptoms and diagnosis using MRI.ResultsMost common initial symptoms for cervical vertebrae tumors were neck pain or pain radiating to one extremity,which accounted for 40%,55% respectively; thoracic vertebrae were low back pain or pain radiating to one extremity,which accounted for 38%,50%;lumbar vertebrae were low back pain or pain radiating to one extremity,which accounted for 87%.The time intervals between onset of the initial symptoms and diagnosis using MRI for cervical,thoracic and lumbar vertebrae were 12.5,14.8 and 8.4 months respectively.ConclusionThe patients with cervical tumors tended to have delayed diagnoses due to the time taken before visiting a physician.Tumors in the thoracic spine were missed because the symptoms were similar to more common degenerative lumbar disorders.
【Key words】
Intradural extramedullary neoplasms; Diagnosis;MRI
椎管硬膜下髓外肿瘤发病率低,且其早期征象不典型,可与其他疾病相混淆,易导致误诊、漏诊[1]。本文回顾性分析了自2002年3月至2008年3月,本院收治的62例椎管硬膜下髓外肿瘤患者的临床资料,探讨引起延迟诊断的原因。
1资料与方法
1.1一般资料自2002年3月至2008年3月在本院行椎管硬膜下髓外肿瘤手术治疗的病例共67例(骨科26例,神经外科41例),其中5例因资料不全被除外。男33例,女29例,年龄6~76岁,平均38岁。术前MRI诊断肿瘤位于颈椎20例,胸椎26例,腰椎16例(为方便统计,位于颈胸段和胸腰段的肿瘤分别记录在颈椎和胸椎)。
1.2记录所有病例的病理诊断、首发症状、首发症状到首次就诊的时间间隔、MRI确诊时的症状、以及从首发症状到MRI确诊的时间间隔。
2结果
肿瘤的病理分类及在颈、胸和腰椎的分布见表1。神经鞘膜瘤是最常见的椎管内髓外肿瘤,占61%。其次是脊膜瘤,占21%。MRI诊断的8例哑铃型肿瘤,病理诊断是神经鞘膜瘤 ......
您现在查看是摘要介绍页，详见PDF附件(2163KB，3页)。