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腰椎圧迫骨折

2011.10.30(19:58)

先日、接骨院の近所に住んでおられる

80代女性が、転倒して腰痛があるとのことで

来院されました。

この場合、まず問診以前に来院時の歩行状態・苦表情等運動痛の程度をそっと観察します。

次に、問診で発生機序を確認。

特に転倒の場合は、アスファルトと畳では滑りやすさや床面の固さが違うので。

そして、年齢性別等から骨粗鬆症(Frのリスクの大きさ)を考えます。

次に痛みの箇所を確認。この方は腰全体とおっしゃいましたので、

筋肉・靭帯の捻挫部位の特定と腰椎の骨折の可能性として、

ハンマーによる叩打痛・皮下出血の有無・急な下肢への神経症状(圧迫骨折でも滅多に出ません)

など総合的に判断し、

この方の場合、腰方形筋の捻挫が主訴部でありましたが、

高確率で腰椎圧迫骨折と判断し、

すぐに紹介状とともに総合病院へ受診していただきました。

(圧迫骨折の大半はコルセット作成まで入院が必要な場合があるため、入院設備のあるところをお勧めしました。)

しかし、患者さまいわくDrはレントゲンを診て

『骨スカスカだね。精査後カルシウム剤内服だね。骨折はないよ。』

と言われたため、すぐ当院へ帰ってこられました。

しかし、やはり骨折の症状があるという判断をして、

もし骨折でなかったら、もう当院は信用してもらえないだろうと思いながら、

セカンドピニオンを依頼。

結果は骨折で即入院でした…。

病院で勤務していた時、何度も腰椎圧迫骨折の見逃しを見ていたため、またかと思い残念でした。

年々直感が鋭くなり、色んな症状を根拠もなく見つけてしまうような気になる時もあります。

医療従事者ならよくある事ですが、常に繰り返し勉強し根拠を素早く

述べる・記録できるようにしておかないといけないと

つくづく思います。
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【2011/11/20 08:50】 | uobftaa #- | [edit]
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【2011/11/25 19:28】 | Organic tea #- | [edit]
Use your passion and geek expertise to liberate the latent creativity that resides in readers, something that works better than the linear, sequential and fast fading stream of comments (yeah, this is recursive). Comments are writing, but lets have something not as we know it. Writing in this box just feel a little klunky, there must be a better way, make a better blog :), http://jamigertznude1.typepad.com jami gertz nude, uzojyq, http://amandacrewhot.typepad.com amanda crew hot, =O, http://nikkireednude.typepad.com nikki reed nude, ilonw, http://mayarudolphnude.typepad.com maya rudolph nude, jvq, http://missyperegrymnude1.typepad.com missy peregrym nude, 1447,
【2011/11/27 18:17】 | Kaitlyn_Connecticut #/BiXzY8M | [edit]
Maybe the private blog is the way to go, though I suspect you'd need some time to get revved up for that. The pod/video angle sounds great, but that raises a lot of other questions. And it loses the immediacy that you enjoyed so long, which is one of the most unfortunate losses in all this., http://snoopdoggnaked.typepad.com snoop dogg naked, 8]]], http://chiakikuriyamanude1.typepad.com chiaki kuriyama nude, 295, http://jamieleecurtishot.typepad.com jamie lee curtis hot, %OOO, http://shannonelizabethhot.typepad.com shannon elizabeth hot, 071605, http://roselynsanchezsex.typepad.com roselyn sanchez sex, >:O,
【2011/11/27 21:18】 | Mia_North_Dakota #zR2MVoIw | [edit]
I think greater interaction among groups would result (mix up the tech bloggers and the marketers and the VCs and the usability people and, hell, even the sex bloggers) ;) and really spark some awesome conversations., http://jennafischersexy.typepad.com jenna fischer sexy, alaqpr, http://jennifertillyporn1.typepad.com jennifer tilly porn, kzf, http://evalongoriadesnuda1.typepad.com eva longoria desnuda, 8-], http://coconudepics.typepad.com coco nude pics, >:-]]], http://fabianaudenionude2.typepad.com fabiana udenio nude, vkiey,
【2011/11/27 21:21】 | Jocelyn_Delaware #LQ9Eobmo | [edit]
Maybe the private blog is the way to go, though I suspect you'd need some time to get revved up for that. The pod/video angle sounds great, but that raises a lot of other questions. And it loses the immediacy that you enjoyed so long, which is one of the most unfortunate losses in all this., http://annakournikovasex.typepad.com anna kournikova sex, 8-(((, http://kirstiealleynude1.typepad.com kirstie alley nude, %))), http://terigarrnude.typepad.com teri garr nude, 565201, http://emmyrossumhot.typepad.com emmy rossum hot, etpmg, http://meganfoxnakedpictures.typepad.com megan fox naked pictures, 4593,
【2011/11/27 21:35】 | Allison_Wyoming #rEYjXkYI | [edit]
I also really enjoy the idea of a group blog mostly because I've always been a fan of group blogs a la 37signals. It's a different take on things that I tend to enjoy, getting to see different opinions, group dynamics, etc., http://zooeydeschanelsexy1.typepad.com zooey deschanel sexy, ivmt, http://kristenstewartdesnuda.typepad.com kristen stewart desnuda, 15712, http://oliviawildesex.typepad.com olivia wilde sex, 08162, http://zacefronhot.typepad.com zac efron hot, 3537, http://keeleyhawesnaked.typepad.com keeley hawes naked, 926,
【2011/11/27 23:21】 | Kaylee_Massachusetts #dVXfOl2M | [edit]
That aside, I think that a multiple-contributor blog would give you support and provide some other perspectives. You could combine this with your ideas on coaching/ghostwriting and work with 'intern' contributors to hone their skills, see their work supplying your site, and give them the tools they need to take your philosophies and understanding out on their own tangents. It might give you a regular supply of fresh, new writers and keep things going while allowing you to step back a little. (If you did go with the intern idea, drop me a line, will you? *g*), http://courtneythornesmithnaked.typepad.com courtney thorne-smith naked, 450, http://mariahcareyboobs.typepad.com mariah carey boobs, =OOO, http://krystenritternude2.typepad.com krysten ritter nude, dxeg, http://evagreenhot.typepad.com eva green hot, =((, http://tilatequilaboobs.typepad.com tila tequila boobs, >:-]]],
【2011/11/28 00:07】 | Natalie_Massachusetts #3GI6f2T2 | [edit]
Honestly said, I don't think you can do anything to fend off the attacks. I don't think you got attacked because of something you did, but because lots of people admire you and your work. That's apparently enough for some people to hate you. Only by unpassionating your readers, can you hope to actually stop the haters. I hope you will reject that option., http://amandatappingporn.typepad.com amanda tapping porn, 8OO, http://catherinezetajonessexy.typepad.com catherine zeta jones sexy, 251, http://leahreminiass.typepad.com leah remini ass, klz, http://gwynethpaltrowbikini.typepad.com gwyneth paltrow bikini, eev, http://evalongoriapussy.typepad.com eva longoria pussy, bpfhl,
【2011/11/28 01:02】 | Lauren_Virginia #CTGnkgHk | [edit]
Is there a way use some sort of third party forum moderation to cut through this problem? Then you could go on in whatever way you are comfortable, your forums could coninue to buzz and anyone that's up to no good would hit a brick wall (or get a call from their local authorities, as appropriate). It's just a thought., http://ashtonkutchersextape.typepad.com ashton kutcher sex tape, sbxfq, http://raquelalessiplayboy.typepad.com raquel alessi playboy, >:(, http://jodiemarshsextape1.typepad.com jodie marsh sex tape, kimqf, http://nicolamcleannude.typepad.com nicola mclean nude, yvk, http://juliannenicholsonnude.typepad.com julianne nicholson nude, eibig,
【2011/11/28 03:25】 | Maria_Texas #J1obyjKI | [edit]
Oodles of bloggers great and small would give a #1 Technorati rank (or insert personal thing of inestimable value here) to be able to host Kathy Sierra as a guest blogger. (Myself included.), http://aliciakeyssextape1.typepad.com alicia keys sex tape, =PPP, http://jillnicolininude.typepad.com jill nicolini nude, 8[[[, http://coconudepics.typepad.com coco nude pics, 798, http://lauraharringnude.typepad.com laura harring nude, =-OO, http://zoeluckernude.typepad.com zoe lucker nude, 5490,
【2011/11/28 03:48】 | Naomi_Rhode_Island #0tUqnPyc | [edit]
Having said all of that, I wonder if Ande's idea isn't the best (regardless of what format you choose to go with for the blog). If it was still public with no comments, but you cross-posted entries in a private forum, you could allow people to respond and discuss in a controlled/private environment, but still keep the blog itself public. I'm not sure how much extra work that would be for you, but if it was negligible I would say that's the best option for running your site the way you have and seem to love, but keeping the riffraff at bay., http://elizadushkutopless.typepad.com eliza dushku topless, 181436, http://leightonmeesterhot1.typepad.com leighton meester hot, %-), http://hopedworaczyknaked1.typepad.com hope dworaczyk naked, 73114, http://juliarobertssex1.typepad.com julia roberts sex, :PPP, http://terapatricknaked.typepad.com tera patrick naked, >:]],
【2011/11/28 03:49】 | Stella_Louisiana #4.jOEVh6 | [edit]
That's fine for the House and Senate but for president, there is no way any conservative should vote for either Democrat that will be stuffed down our throats next year. The House is the grand prize. If we had someone like Jim Jordan as Speaker and more than the current 3 reliable conservative senators, the president wouldn't matter., http://jessicasimpsontits1.typepad.com jessica simpson tits, 9034, http://georgiethompsonnude1.typepad.com georgie thompson nude, jqqmi, http://ashleytisdalesexy2.typepad.com ashley tisdale sexy, 659004, http://nigellalawsonbreast.typepad.com nigella lawson breast, =-)), http://hollymadisontits.typepad.com holly madison tits, %]],
【2011/11/28 07:30】 | Eva_New_Jersey #ODDVjhtk | [edit]
Use your passion and geek expertise to liberate the latent creativity that resides in readers, something that works better than the linear, sequential and fast fading stream of comments (yeah, this is recursive). Comments are writing, but lets have something not as we know it. Writing in this box just feel a little klunky, there must be a better way, make a better blog :), http://christamillernude1.typepad.com christa miller nude, 8-]]], http://drewbarrymoresexy.typepad.com drew barrymore sexy, omuzp, http://heathergrahamsexvideo.typepad.com heather graham sex video, rzaj, http://keiraknightleynudepics.typepad.com keira knightley nude pics, 667480, http://katehudsonass1.typepad.com kate hudson ass, :PPP,
【2011/11/28 09:09】 | Aaliyah_Louisiana #vEJfsWLI | [edit]
Just look at the difference just 20-30 rock solid Tea Party conservatives have made in the House already. They've turned "1/3 of the government" on its head and started a war between the establishment party and the Tea Party., http://joshduhamelnaked1.typepad.com josh duhamel naked, ahjtdw, http://oliviawildeporn.typepad.com olivia wilde porn, %-O, http://jenniferlovehewittnipple.typepad.com jennifer love hewitt nipple, slko, http://tarareiddesnuda.typepad.com tara reid desnuda, yvt, http://natalieimbruglianude1.typepad.com natalie imbruglia nude, 455184,
【2011/11/28 09:59】 | Bella_New_Hampshire #SFelRZds | [edit]
Has he joined Obama in Wonderland where up is down and left is right? What's "fiscally conservative" about voting for every spending measure in sight?, http://sarahjessicaparkersexscene.typepad.com sarah jessica parker sex scene, xwawa, http://morganfairchildhot.typepad.com morgan fairchild hot, 126, http://nathaliekelleynaked1.typepad.com nathalie kelley naked, 798389, http://davinamccallnaked.typepad.com davina mccall naked, 8-P, http://ushernude.typepad.com usher nude, cuh,
【2011/11/28 14:27】 | Peyton_Connecticut #lAg4889M | [edit]
What is really infuriating is his denial that he was attacking the Tea Party. He was "only reading a WSJ article" on the floor of the Senate. Hannity could have done a better job of hammering on THAT giant piece of brazen hypocrisy., http://emmastonesex.typepad.com emma stone sex, huivf, http://deepikapadukonenaked.typepad.com deepika padukone naked, 406343, http://alexandradaddariohot.typepad.com alexandra daddario hot, 312, http://arnoldschwarzeneggernude.typepad.com arnold schwarzenegger nude, 870, http://keeleyhawesnaked.typepad.com keeley hawes naked, 8-))),
【2011/11/28 16:57】 | Maya_North_Dakota #T0gBzX3c | [edit]
I think that you'd probably do well in a consulting role where you are helping companies who want to improve in the area of creating passionate users (products and websites). Your knowledge of the field is shown well by your blogging, and maybe getting out in front of people will give you more of a reason to stay passionate about this subject area (if not the blog itself)., http://gillianjacobsnude1.typepad.com gillian jacobs nude, ntrnie, http://drakebellnude.typepad.com drake bell nude, :[, http://victoriasilvstedtplayboy.typepad.com victoria silvstedt playboy, tca, http://rachelbilsonsexy.typepad.com rachel bilson sexy, %-D, http://eminemsex.typepad.com eminem sex, 1424,
【2011/11/28 18:31】 | Jocelyn_Rhode_Island #6N3Aa8Bg | [edit]
In relation to the Technorati rank it's pulled down via an API (geez I think that's what it's called) as is Alexa rank & the script calculates the index - I just need to record the figures in a spreadsheet for upload., http://rachelbilsonbikini.typepad.com rachel bilson bikini, =DD, http://nicolerichienaked.typepad.com nicole richie naked, %)), http://haifawehbenude.typepad.com haifa wehbe nude, jmn, http://juliannemooresex.typepad.com julianne moore sex, 8P, http://lindsaypricenude.typepad.com lindsay price nude, ugl,
【2011/11/28 19:26】 | Faith_New_Mexico #tGsBzjYs | [edit]
It'd be kinda like the group blog idea, but with more of a "Where in the World is Carmen Sandiego?" vibe. And who didn't love playing that? :), http://robinmeadenude.typepad.com robin meade nude, :-OOO, http://vikkiblowsnude.typepad.com vikki blows nude, %-((, http://keiraknightleyfake.typepad.com keira knightley fake, %PP, http://katherineheigltopless1.typepad.com katherine heigl topless, :-OOO, http://ajcookhot.typepad.com aj cook hot, 681,
【2011/11/28 19:44】 | Brooklyn_Arkansas #a7QB/iKY | [edit]
Oodles of bloggers great and small would give a #1 Technorati rank (or insert personal thing of inestimable value here) to be able to host Kathy Sierra as a guest blogger. (Myself included.), http://annakournikovasex.typepad.com anna kournikova sex, >:-((, http://lindafiorentinonude1.typepad.com linda fiorentino nude, =-], http://alysonhanniganhot.typepad.com alyson hannigan hot, 216, http://adrianalimaass.typepad.com adriana lima ass, 081412, http://renasofernude.typepad.com rena sofer nude, 879,
【2011/11/28 21:06】 | Morgan_Michigan #xV/NFf8Y | [edit]
Having said all of that, I wonder if Ande's idea isn't the best (regardless of what format you choose to go with for the blog). If it was still public with no comments, but you cross-posted entries in a private forum, you could allow people to respond and discuss in a controlled/private environment, but still keep the blog itself public. I'm not sure how much extra work that would be for you, but if it was negligible I would say that's the best option for running your site the way you have and seem to love, but keeping the riffraff at bay., http://dreadematteohot.typepad.com drea de matteo hot, >:-(((, http://emilyosmentsexy.typepad.com emily osment sexy, =O, http://patriciaheatonfakes.typepad.com patricia heaton fakes, kdu, http://ashleygreenehot.typepad.com ashley greene hot, mub, http://kerryfoxnude.typepad.com kerry fox nude, kvyhu,
【2011/11/28 22:43】 | Leah_New_Mexico #DKkHWk/Q | [edit]
Honestly said, I don't think you can do anything to fend off the attacks. I don't think you got attacked because of something you did, but because lots of people admire you and your work. That's apparently enough for some people to hate you. Only by unpassionating your readers, can you hope to actually stop the haters. I hope you will reject that option.,
【2012/04/04 03:42】 | Amelia_Pennsylvania #Oi87a9VE | [edit]
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