股骨头坏死误诊为腰椎间盘突出症原因分析

The cause of misdiagnosis of osteonecrosis of the femoral head for lumbar intervertebral disc protrusion disease

目的 分析股骨头坏死误诊为腰椎间盘突出症的原因。方法 收集和诊查有明确误诊为腰椎间盘突出症经历并有腰部CT或MRI检查的患者 2 7例。结果 股骨头坏死误诊为腰椎间盘突出症 2 4例 ,并发腰椎间盘突出症漏诊股骨头坏死 3例 ,再次评价其腰部CT、MRI检查资料 ,存在腰椎间盘退变 2 6例 ;腰椎间盘突出 2 4例 ;腰椎体骨坏死 2例。结论 临床病史资料了解不详 ,对类似症状未进行必要的鉴别 ,忽视临床查体 ,依赖CT、MRI检查结论 ,是误诊的关键因素 ;提出股骨头坏死与其并发的腰椎间盘退变和突出可能存在病理相关性 。

Objective To analyze the cause of misdiagnosis of osteonecrosis of femoral head (ONFH) for lumbar intervertebral disc protrusion disease(LIDPD) Methods The history records of 27 patients with misdiagnosis of LIDPD examined with magnetic resonance imaging(MRI) or copmputer assisted tomograhpy(CT) of the lumbar spine were analyzed.Results 24 patients with ONFH were mistaken for LIDPD;3 patients with LIDPD on top of ONFH failed to have the correct diagnose of ONFH.The imaging data of CT or MRI were reviewed for a second time;There were 26 patients with lumbar intervertebral disk degeneration;24 patients with lumbar intervertebral disc protursion;2 patients with osteonecrosis of lumbar vertebral body.Conclusion A frequent cause of misdiagnosis is the negligence of detailed analysis of the patient′s history;differential analysis of similar clinical symptoms is also important.The establishment of the diagnosis solely depending upon the conclusion of CT or MRI examination is not always reliable.The suggestion that a possible correlation in pathophiology exists in between lumbar intervertebral disc protrusion and ONFH is another factor of misdiagnosis..