髋关节骨性关节炎误诊为股骨头坏死原因分析

Misdiagnosis causes of primary hip osteoarthritis as osteonecrosis of the femoral head

目的探讨原发性髋关节骨性关节炎误诊为股骨头坏死骨关节炎原因。方法回顾性分析233例264髋行全髋关节置换的原发性髋关节骨关节炎患者的临床资料。结果经综合X片、CT、MRI、术中观察及术后病理,有33例40髋在术前误诊为缺血性股骨头坏死骨关节炎期,误诊率为15.15%所有患者X线片、CT有关节间隙狭窄、软骨下骨硬化、囊性变及骨赘形成,有13例18髋表现为轻度髋臼发育不良,MRI有2例股骨头骨髓水肿,术中观察及术后病理明确排除股骨头缺血性坏死。结论对影像学检查进行仔细分析,结合术中观察及术后病理,可减少误诊。

Objective To investigate the cause of misdiagnosis of primary hip osteoarthritis as osteonecrosis of the femoral head. Methods X-ray, CT, MRI, intraoperative observation and pathologic examination results of 264 hip of 233 cases who suffered THA were retrospectively reviewed. Results 33 patients with primary hip osteoarthritis were misdiagnosed as osteonecrosis of femoral head before operation among 233 patients who underwent THA, the misdiagnosis rate was 15. 15%. Joint space narrowing, subchondral sclerosis, osteophytes and subchondral cyst were shown in all patients X-ray and CT examination. Mild acetabular dysplasia was found in 18 hips of 13 cases. Bone marrow edema-like signal could be found in two femoral heads by MRI. Intraoperative morphologic finding and postoperative histopathologic examination of femoral heads definitely ruled out avascular necrosis of femur head. Conclusion The misdiagnosis could be reduced by carefully analyzing various imaging examinations combined with intraoperative observation and pathologic examination.