| 颈神经后支源性颈肩痛的临床特点和误诊分析 |
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Received:July 10, 2003
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| 期刊信息：《中国骨伤》2004年17卷，第1期，第3-6页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
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目的:分析颈神经后支源性颈肩痛的临床特点并探讨其误诊原因。
方法:对75例中颈痛14例,颈肩痛38例,肩背痛23例,误诊为颈椎病35例,肩背肌筋膜炎21例,肩周炎19例的病历资料进行回顾性研究。分别采取颈神经后支阻滞配合手法以及肩关节腔内液压扩张加手法松解。
结果:75例平均随访8个月,总优良率88%。与误诊疗效率、症状一时减轻613%、完全无效387%相比,差异有显著性(P<005)。该类型颈肩痛具有以下临床特点:①疼痛常常不表现在它的病理改变部位;②缺乏神经病理阳性体征或神经根刺激征;③物理学和影像学结果不相符合;④颈椎关节突关节固定性压痛,受累后支支配区牵涉痛和压痛或肌痉挛;⑤影像学检查,关节突关节呈退行性改变。
结论:临床表现的相似性;可能存在的病理相关性;诊断思维的局限性;治疗方法的雷同性;疗效短暂的有效性;均可能是造成误诊的主要原因。重视病史和临床检查,以触诊定位,神经定位,结合影像学资料,是提高诊疗水平,防止误诊的关键。 |
| [关键词]:神经卡压综合征 颈痛 肩痛 误诊 |
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| Analysis on the clinical characteristics and the cause of clinical misdiagnosis of cervicoscapular pains originated from dorsal rami of cervical nerves |
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Abstract:
Objective:To analyze the clinical characteristics and the cause of misdiagnosis of cervicoscapular pains originated from the dorsal rami of cervical nerves.
Methods:The medical history of 75 cases had been retrospectively analysed and treated with blockage of dosal rami of cervical nerves,manipulation and hydraulic distension with manipulation release were analyzed,among them,14 cases were neck pain,38 cases were neck-shoulder pain,23 cases were shoulder-back pain,35 cases were misdiagnosed as cervical spondylosis,and 21 cases as back myofascitis and 19 cases as periarthritis of shoulder.
Results:All the cases had been followed up for 8 months,there was significant difference (P<0.05)compared the excellent and good rate(88%)with misdiagnosis rate and inefficient rate(38.7%)and the rate of temporary alleviation(61.3%).Clinical characteristics of such kind of neck-shoulder pain are as follows:①Pain does not always manifest at the place,where pathological change occurs.②There was lack of neuro-pathological signs or symptoms or stimulant syndrome of nerve roots.③The physical result was not accorded with the result of radiology.④Fixed tenderness manifested at joints of cervical vertebral processes involved pain with tenderness or muscular spasm shows at place,where implicated the domination of dosal rami of cervical nerves.⑤Retrogressive change occurs at joints of cervical vertebral processes,shown by radiological examination.
Conclusion:The misdiagnosis results might come from the similarity in clinical menifestations,possible existence of pathophysiological interrelationship,limitation of diagnostic thinking,similarity of therapeutical methods,transient therapeutic effectiveness,etc.Might be the main causes of misdiagnoses.Paying great attention on the medical history record and clinical examination,diagnostic localization of the illness of nerve with palpation,combined with radiological materials would be the key point for prevention from misdiagnosis. |
| KEYWORDS:Nerve compression syndromes Neck pain Shoulder pain Diagnostic errors |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 王希,袁君君,李瑛.颈神经后支源性颈肩痛的临床特点和误诊分析[J].中国骨伤,2004,17(1):3~6 |
| 英文格式: | WANG Xi,YUAN Jun-jun,LI Ying.Analysis on the clinical characteristics and the cause of clinical misdiagnosis of cervicoscapular pains originated from dorsal rami of cervical nerves[J].zhongguo gu shang / China J Orthop Trauma ,2004,17(1):3~6 |
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