摘要
目的探讨股骨头坏死误诊为腰椎间盘突出症的原因及防范措施。方法回顾分析2016年4月—2021年3月收治的误诊为腰椎间盘突出症的股骨头坏死12例的病例资料。结果12例均有不同程度的腰骶部、大腿周围酸痛不适和僵硬感,伴左侧下肢疼痛6例、右侧下肢疼痛4例、双侧下肢疼痛2例,以夜间疼痛明显,伴轻度跛行10例,休息后可缓解;单侧患病10例(左侧6例、右侧4例),双侧患病2例。12例病程3~10个月;诱发因素:大量饮酒4例,长期大量使用糖皮质激素3例,髋部外伤史2例,原因不明3例。12例CT检查示椎间盘均有轻微膨出。12例据上述症状体征及影像学检查结果,诊断为腰椎间盘突出症,经牵引、按摩、针灸等治疗后症状无明显减轻且逐渐加重。转院后查体发现疼痛侧髋关节活动范围缩小,患髋叩击痛均(+),8例“4”字试验(+);MRI检查均发现股骨头缺血坏死征象。遂确诊为股骨头坏死,Ficat分期:Ⅲ期8例、Ⅳ期4例。误诊时间2~5个月。8例Ⅲ期患者行股骨头保护性手术治疗,4例Ⅳ期患者行髋关节置换术。术后随访2年,预后良好。结论股骨头坏死早期患者症状体征不典型,部分患者以腰臀部疼痛或下肢疼痛为主要症状就诊,髋部症状缺如,在未行髋部MRI检查前极易误诊为腰椎间盘突出症;详细询问患者有无相关诱发因素,仔细髋部查体,及早行髋部MRI检查,认真鉴别诊断,有利于本病的早期诊治。
Objective To explore the causes and preventive measures of misdiagnosis of femoral head necrosis(FHN)as lumbar disc herniation(LDH).Methods A retrospective analysis was made of 12 patients with FHN misdiag⁃nosed as LDH from April 2016 to March 2021.Results All the 12 patients had pain,discomfort and stiffness around the lumbosacral region and thighs to varying degrees,accompanied by left lower limb pain in 6 cases,right lower limb pain in 4 cases,bilateral lower limb pain in 2 cases,with the pain more obvious at night,accompanied by mild claudication in 10 ca⁃ses,which could be relieved after rest.There were 10 cases with unilateral disease(6 cases on the left side and 4 cases on the right side)and 2 cases with bilateral disease.The course of disease was 3⁃10 months in 12 cases.As for triggering factors,there were 4 cases with a history of heavy drinking,3 cases of longterm use of glucocorticoid,2 cases with a history of hip trauma,3 cases of unknown cause.CT examination of 12 cases showed slight bulging of intervertebral disc.According to the above symptoms,signs and imaging results,12 cases were diagnosed as LDH.After traction,massage,acupuncture and other treatment,the symptoms did not significantly relieve and gradually aggravated.Based on physical examination after hospital transfer,it was found that the range of motion of the hip joint on the painful side was reduced,and the hip percussion pain was all(+),and 8 cases of Patrick's test(+);MRI examination showed signs of ischemic necrosis of the femoral head;there⁃fore,FHN was confirmed.The Ficat stage wasⅢin 8 cases andⅣin 4 cases.Misdiagnosis took 2 to 5 months.Eight pa⁃tients in stageⅢunderwent protective operation on femoral head,and four patients in stageⅣunderwent hip replacement.They were followed up for 2 years,and the prognosis was good.Conclusion The symptoms and signs of early FHN are not typical.Several patients presented with pain in lumbar and hip areas or lower limb pain as the main symptom,but are lack of hip symptoms,which i
作者
崔阳
李星瑶
周医斋
薛辉
CUI Yang;LI Xingyao;ZHOU Yizhai;XUE Hui(Department of Orthopedics,the Second Central Hospital of Baoding City,Zhuozhou,Hebei 072750,China;Department of Emergency,the Second Central Hospital of Baoding City,Zhuozhou,Hebei 072750,China)
出处
《临床误诊误治》
CAS
2023年第5期19-22,共4页
Clinical Misdiagnosis & Mistherapy
关键词
股骨头坏死
误诊
椎间盘移位
诱发因素
髋部
叩击痛
MRI检查
鉴别诊断
Femur head necrosis
Misdiagnosed
Intervertebral disc displacement
Triggering factor
Hip
Percus-sion pain
MRI examination
Differential diagnosis
