摘要

目的：胸鎖關節肥厚性骨炎是一種少見的前胸壁慢性無菌性骨髓炎，病因不清，常常與特征性的掌蹠膿皰病相關。該病在確診前常常被延誤多年。本研究目的是追溯這類患者的診斷軌跡，以研究診斷延誤的後果。

方法：回顧性收集分析52例經臨床、核醫學以及放射科確診的胸鎖關節肥厚性骨炎患者的資料。

結果：大多數患者表現為胸鎖關節部位的腫痛或者肩帶肌附近的活動受限。約30%的患者合並掌蹠膿皰病。診斷延誤的時間為3.5年左右。在確診前患者往往就診於3個科室以上。對該病臨床表現認識的缺乏以及診斷的延誤與患者身體、精神以及社會經濟上的不良後果密切相關，顯著影響患者生活質量。

結論：胸鎖關節肥厚性骨炎盡管特點鮮明，仍然極易被誤診。對該病認識不足導致延誤診斷會對患者生活的多個方麵造成顯著的不利影響。提高對該病的認識，使得患者能夠及時得到診斷和治療，有助於減輕患者因診斷延誤而不能得到治療帶來的身體和精神痛苦。

附原文

OBJECTIVE: Sternocostoclavicular hyperostosis (SCCH) is a rare, debilitating, chronic inflammatory disorder of the anterior chest wall due to a chronic sterile osteomyelitis of unknown origin, often associated with characteristic skin lesions of palms and soles: pustulosis palmoplantaris. SCCH goes often unrecognized for years before the diagnosis is established and treatment instituted. The objective of this study was to trace the diagnostic paths of patients with SCCH and to investigate the consequences associated with diagnostic delay.METHODS: Data were collected through structured interviews of 52 patients with a clinically, scintigraphically, and radiologically established diagnosis of SCCH.RESULTS: The majority of patients presented with swelling and/or pain in the sternocostoclavicular region and/or limited movement of the shoulder girdle. Pustulosis palmoplantaris was present in approximately 30% of patients. The disease went unrecognized for a median of 3.5 years. Patients were often seen by at least 3 members of the medical profession before the diagnosis was suspected and eventually established. Lack of recognition of the clinical manifestations of the disease and delay in diagnosis were associated with important physical, psychological, and socioeconomic consequences affecting quality of life.CONCLUSION: SCCH remains an ill-recognized disease despite its characteristic clinical features. A low level of awareness of the disorder leads to a delay in diagnosis, which has a significant impact on various aspects of quality of life. Awareness should be raised for this disorder, enabling timely diagnosis and initiation of treatment to prevent the irreversible physical and psychological sequelae associated with the protracted untreated state..

引自

van der Kloot WA, Chotkan SA, Kaptein AA, Hamdy NA. Diagnostic delay in sternocostoclavicular hyperostosis: impact on various aspects of quality of life.Arthritis Care Res (Hoboken). 2010 Feb;62(2):251-7.