原发性髋关节骨关节炎误诊为股骨头坏死六例分析

Clinical Analysis of Six Cases of Primary Hip Osteoarthritis Misdiagnosed as Femoral Head Necrosis

目的探讨原发性髋关节骨关节炎误诊为股骨头坏死的原因及防范措施,以提高诊治水平。方法回顾性分析原发性髋关节骨关节炎21例中误诊为股骨头坏死6例的临床资料。结果本组误诊率为28.57%。6例因髋关节疼痛伴或不伴晨僵就诊,均曾误诊为股骨头坏死,误诊时间1~4个月,给予保守治疗,病情均无明显好转。后通过CT、MRI及术后病理等检查确诊为髋臼发育不良性髋关节骨关节炎2例,原发性髋关节骨关节炎4例。6例均行手术治疗后病情好转出院;出院后随访3个月~1年,均预后良好。结论原发性髋关节骨关节炎缺乏特异性临床症状和体征,临床医生应提高对其警惕性,并加强对其临床表现及影像学检查结果的认识和了解,以减少或避免该病误诊误治。

Objective To explore the causes and preventive measures of primary hip osteoarthritis misdiagnosed as necrosis of the femoral head,in order to improve diagnosis and treatment. Methods Of 21 patients with primary hip osteoarthritis. clinical data of 6 with misdiagnosed femoral head necrosis were retrospectively analyzed. Results The rate of misdiagnosis in this group was 28.57%. Six patients who presented with hip joint pain with or without morning stiffness,were misdiagnosed as having necrosis of the femoral head. Duration of misdiagnosis was 1 - 4 months.Conservative treatment failed for there was no obvious improvement. CT,MRI and postoperative pathological examination confirmed hip osteoarthritis due to acetabular dysplasia in 2 cases,and primary hip osteoarthritis in 4. All 6 patients were discharged after surgical treatment,and were followed up for 3 months to 1 years,and the prognosis was favorable. Conclusion There are no specific clinical symptoms and signs in terms of primary hip osteoarthritis. Therefore,clinicians should enhance the understanding of clinical manifestations of primary hip osteoarthritis and imaging examination results,to reduce or avoid misdiagnosis and mistreatment.