腰椎疾患診断における病歴の重要性の検討

Diagnostic Significance of Patient History in Lumbar Spinal Diseases

　抄録：病歴のみで腰椎部疾患の診断がどの程度可能であるかを調査するため，診断が確定している腰椎10疾患，100例の病歴を抽出し，整形外科医53名にこれらの病歴のみからの診断を依頼した．そして卒後年数，専門医資格および脊椎専門病院での研修歴の有無による診断率の差について比較検討した．2回答選択性とし，どちらかが正解であれば正答とすると，全体では75％の高い正答率が得られた．しかし，卒後5年未満の研修医はそれ以上の医師と比較して有意に正答率が低かった．また日整会の非専門医であっても脊椎専門病院で研修した医師は日整会専門医と同率の正答率を得ており，研修の重要性が確認できた．10疾患のうち正答率が特に低かったのは分離すべり症，化膿性脊椎炎，椎間孔外ヘルニア，馬尾腫瘍の4疾患であった．十分な病歴と神経学的所見に基づき，適切な補助診断法を選択する必要があると考えられた．

　Importance of patient history is invulnerable to obtain precise diagnosis in the lumbar spinal diseases. Skill of taking history is closely related to doctor's experience, however, diagnostic varience due to doctor's specialty and their experience have not been reported. The Purpose is to study diagnostic rate from given histories in orthopaedic surgeons with various experience and specialty. Histories obtained from medical charts of the 100 hospitalized patients whose daiagnosis had been confirmed, were selected by a sole author. Testees, 53 orthopaedic surgeons with 2-24 years experience, chose 2 answers from given 10 lumbar diseases；disc herniation, farlateral disc herniation, spinal stenosis, spondylolysis-listhesis, compression fracture, caudal tumor, extradural hematoma, metastatic tumor, pyogenic spondylitis, and facet syndrome. The rate of correct answers were compared among the following 4groups；JOA board-certified spinal surgeon, board-certified non-spinal surgeon, resident who had training in hospitals specialized in spine, and residents who had not. Over-all correct rate was 75％ with two answers. Correct rates of doctors who had experience more than 5 years were significantly higher than those of under 5 years. Even in the residents, testees who had trained in special hospital for spine obtained higher correct rates. Among the ten diseases, spondylolysis-listhesis, far-lateral disc herniation, pyogenic spondylitis, and caudal tumor, showed significantly lower correct rates. In this study, orthpaedic surgeons with more than 5 years experience were able to obtain higher correct rate in the diagnosis from given histories. Precise diagnosis will be obtained by taking adequate history and neurological findings, however, attention should be paid in the diagnosis of above 4 lumbar diseases.