易于误诊为股骨头坏死的股骨头内病变的鉴别诊断  

Differential diagnosis of the lesions within the femoral head and osteonecrosis of the femoral head: a retrospective study

作　　者：马金辉[1] 郭万首[2] 李子荣[2] 史振才[2] 王卫国[2] 孙伟[2] 岳德波[2] 张念非[2] 

机构地区：[1]北京大学中日友好临床医学院骨关节外科,北京100029 [2]北京中日友好医院骨关节外科骨坏死与关节保留重建中心,北京市100029

出　　处：《中国骨与关节外科》2017年第1期52-57,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:股骨头内病变与股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)的临床特征,尤其是影像学表现有相似之处,容易造成误诊,但关于股骨头内病变与ONFH鉴别诊断的报道甚少。目的:探讨股骨头内病变与ONFH的鉴别诊断流程,以提高临床诊疗水平。方法:回顾性分析2011年1月至2015年7月收治的有ONFH误诊史的股骨头内病变患者21例,参照ONFH的诊断标准及影像学特点,对股骨头内病变的病例特点、临床表现以及影像学特征进行逐一对比分析。结果:21例患者经影像学分析确诊13例,经术中冰冻病理确诊3例,其余5例经术后石蜡病理证实。分别为软骨下不全骨折软骨下不全骨折(subchondral insufficient fracture,SIF)5例,色素沉着绒毛结节滑膜炎(pigmented villonodular synovitis,PVNS)8例,股骨头内肿瘤及肿瘤样病变8例。结论:对病史、临床表现及影像学资料进行详细的分析,结合ONFH的诊断标准,可提高股骨头内病变的诊断准确率,对选择合理、个体化的治疗方式,避免误诊及过度治疗均有重要作用。Background： There are several overlapping characteristics between the lesions within the femoral head and osteonecrosis of the femoral head（ONFH）, especially in their radiological findings. There are few reports on the differential diagnosis of the lesions in the femoral head and ONFH. Objective： To investigate the differential diagnosis process of the lesions in femoral head and ONFH. Methods： In this retrospective study, 21 patients with the lesion in the femoral head which was inclined to be misdiagnosed as ONFH in our hospital between January 2011 and July 2015 were enrolled. According to the diagnostic criteria and radiological features of ONFH, the characteristics, clinical manifestations and imaging features of the lesion in femoral head were compared with ONFH and summarized one by one. Results： Of the 21 patients, 13 were confirmed by radiological examinations, 3 by intraoperative frozen pathologies and 5 by postoperative paraffin pathologies.There were 5 patients diagnosed as subchondral insufficiency fracture（SIF）, 8 as pigmented villonodular synovitis（PVNS）and 8 as tumor and tumor-like lesion in the femoral head. Conclusions： The detailed analysis of clinical history, manifestations and imaging data as well as the diagnostic criteria of ONFH can improve the diagnostic accuracy of the lesion in the femoral head.

关 键 词：股骨头坏死 诊断 鉴别 影像学 

分 类 号：R681.8[医药卫生—骨科学]