成人非创伤性股骨头坏死入院资料的分析△（开放获取）

Analysis of in-patient data of adult non-traumatic necrosis of femoral head

摘要:

[目的]回顾性分析 2018 年 1 月—2023 年 1 月诊断为非创伤性股骨头坏死（osteonecrosis of femoral head, ONFH）并接受手术治疗的住院患者的临床资料，分析其病因、临床诊断及误诊的现况，为本病的预防、诊断和治疗提供参考。[方法] 收集患者的临床资料：性别、年龄、病因、分期及首次就诊医院级别、诊断等。将数据录入信息表格并进行统计和分析。[结果] 180 例 ONFH 患者纳入研究，激素性占比 55.6%、酒精性占比 30.6%、特发性占比 13.9%。激素性 ONFH 平均发病时间 （17.3±3.7）个月，平均使用剂量（9.3±3.7）g；酒精性 ONFH 饮酒时间平均（15.7±6.9）年，平均每日饮酒（374.7±163.6）mL； 特发性 ONFH 无明显诱因。酒精组患者平均年龄显著大于激素组和特发组 [(44.9±9.8) 岁 vs (39.2±13.6) 岁 vs (39.7±10.2) 岁, P= 0.005]；酒精组男性比例最高，为 98.2%，特发组女性比例较高，为 32.0%，差异有统计学意义（P＜0.05）；酒精组病程显著长于激素组和特发组 [(18.2±6.0) 个月 vs (15.3±2.7) 个月 vs (8.7±3.3) 个月, P=0.013]。三甲医院首次就诊确诊率最高，为 61.9%，一级医院最低，为 22.2%，差异有统计学意义（P＜0.05）。ONFH 最容易被误诊为腰椎间盘突出症。[结论]非创伤性 ONFH 患者以中年男性为主，激素的使用仍然是 ONFH 发病的首要原因。ONFH 的误诊率较高。

Abstract:

[Objective] To retrospectively analyze the etiology, clinical diagnosis and current status of misdiagnosis of the inpatients who were undergoing surgical treatment for non-traumatic osteonecrosis of femoral head (ONFH) between January 2018 and January 2023 for providing a reference of the prevention, diagnosis and treatment of this disease. [Methods] Clinical data of patients were collected, involving gender, age, etiology, stage, grade of hospital at first visiting, diagnosis, etc. The data were listed in the information table and statistic analysis was conducted. [Results] A total of 180 patients with ONFH were included in the study, 55.6% were steroid, 30.6% were alcoholic, and 13.9% were idiopathic. The average onset time of steroid ONFH was (17.3±3.7) months, with the average dose of (9.3±3.7) g; the average drinking of alcoholic ONFH lasted for (15.7±6.9) years, with the average drinking of (374.7±163.6) mL per day, while the idiopathic ONFH had no obvious cause. The mean age of patients in alcohol group was significantly higher than that in steroid group and idiopathic group [(44.9±9.8) years vs (39.2±13.6) years vs (39.7±10.2) years, P=0.005]. The proportion of male in the alcohol group was the highest (98.2%), while the proportion of female in the idiopathicgroup was the highest (32.0%), with statistically significant differences (P＜0.05). The course of disease in the alcohol group was significantly longer than that in the steroid group and the idiopathic group [(18.2±6.0) months vs (15.3± 2.7) months vs (8.7±3.3) months, P=0.013]. The diagnosis rate at the first visit was the highest (61.9%) in the top grade hospitals, and the lowest (22.2%) in the primary hospitals, with statistical significance (P＜0.05). The ONFH was most commonly misdiagnosed as lumbar disc herniation. [Conclusion] The majority of non-traumatic ONFH patients are middle-aged men, and hormone use is still the primary cause of ONFH. The misdiagnosis rate of ONFH is higher.