目的 分析股骨头缺血性坏死误诊为腰椎间盘突出症的形成原因,提出预防对策.方法 回顾性分析我院2006年1月～2010年12月收治并误诊为腰椎间盘突出症的17例股骨头缺血性坏死的临床资料.结果 17例中单侧股骨头坏死12例,双侧5例,共22个股骨头坏死延误诊断,发病到确诊时间5～18个月,平均10个月.按Ficat及Arlet分期,Ⅰ期2个,Ⅱa期5个,Ⅱb期5个,Ⅲ期6个,Ⅳ期4个.6例误行腰椎间盘手术,2例行髋部X线、CT检查不能确诊股骨头缺血性坏死,后经MRI、放射性核素扫描(ECT)检查明确诊断.17例确诊后根据分期的不同13个股骨头实施了全髋关节置换术,6个实施了髓内减压钽棒置人,3个实施了髓内减压植骨,症状均明显减轻.结论 对可疑股骨头缺血性坏死病例应及早行ECT、MRI检查,且影像学检查与临床检查要密切结合,严格执行腰椎间盘手术指征,制定合理的临床路径是防止股骨头缺血性坏死误诊的重要措施.%Objective To analyze the causes of avascular necrosis of the femoral head misdiagnosed as lumbar disc hemiation, and investigate clinical preventive measures. Methods The clinical data of 167 patients with avascular necrosis of the femoral head misdiagnosed as lumbar disc hemiation in our hospital during January 2006 and December 2010 were retrospectively analyzed. Results Among the 17 patients with avascular necrosis of the femoral head, 12 were unilateral, and S were bilateral. A total 22 femur heads were misdiagnosed for 5 to 18 months (an average of 10 months). According to Ficat and Ariel stage, 2 were oflstage, 5 of Qa stage, 5 of Ob stage, 6 of HI stage, and 4 of IV stage. 6 patients were mistreated with lumbar disc surgery. 2 patients could not be diagnosed by hip X ray, CT examination, but diagnosed as having avascular necrosis of the femoral head by MR and emission computerized tomography (ECT) examinations. According to the different stages, 13 femur heads were implementated by total hip replacement surgery, 3 by intramedullary decompression of the hip bone, and 6 by intramedullary decompression implementation of tantalum rod insertion, and the symptoms were alleviated significantly. Conclusion Suspected patients with avascular necrosis of the femoral head should be detected by ECT and MRI. Integrating imaging studies with the clinical examination closely, implementing indications of lumbar disc surgery strictly, and making rational clinical pathway is an important measure to prevent the occurrence of misdiagnosis.
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