| 股骨头坏死误诊相关因素研究 |
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摘要点击次数: 1756
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投稿时间：2017-04-14
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| 作者 | Author | 单位 | Address | E-Mail |
| 陈志伟 |
CHEN Zhi-wei |
中国中医科学院望京医院骨关节三科, 北京 100102 |
The Third Department of Bone and Joint, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 李泰贤 |
LI Tai-xian |
中国中医科学院望京医院骨关节三科, 北京 100102 |
The Third Department of Bone and Joint, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 万晓旭 |
WAN Xiao-xu |
中国中医科学院望京医院骨关节三科, 北京 100102 |
The Third Department of Bone and Joint, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 王荣田 |
WANG Rong-tian |
中国中医科学院望京医院骨关节三科, 北京 100102 |
The Third Department of Bone and Joint, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 陈卫衡 |
CHEN Wei-heng |
中国中医科学院望京医院骨关节三科, 北京 100102 |
The Third Department of Bone and Joint, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
drchenweiheng@163.com |
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| 期刊信息：《中国骨伤》2017年，第30卷，第11期，第1000-1003页 |
| DOI：10.3969/j.issn.1003-0034.2017.11.006 |
| 基金项目:“十二五”国家科技支撑计划项目（编号：2015BAI04B03）；北京市自然科学基金资助项目（编号：7142170） |
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中文摘要:
目的：分析股骨头坏死误诊现状及相关因素，为股骨头坏死的准确诊断提供依据。
方法：收集自2015年3月至2016年3月髋关节疾病患者314例，设定首次诊断后，同样症状体征半年内第2次就诊与首诊不一致或与专家组所给诊断不一致者为误诊标准。将一般资料、发病诱因、发病时间、就诊医院、临床表现、髋关节X线片、MRI等资料进行统计处理。用Logistic回归模型对股骨头坏死误诊相关因素分析研究。
结果：共127例曾经历过股骨头坏死误诊，总误诊率达到40.8%，其中股骨头坏死被误诊为其它疾病占77.2%，其它疾病被误诊股骨头坏死占22.8%；采用单因素分析，误诊与发病诱因、激素使用史、饮酒史、发病侧别、疼痛侧别、疾病隐匿情况、首诊医院级别、首诊专家级别等有相关性（P<0.05），误诊与性别、年龄、使用激素原发疾病、激素使用方法、激素使用时间、饮酒种类、饮酒年限等均无相关性（P>0.05）。股骨头坏死被误诊为其他疾病Logistic回归分析显示，隐匿起病和患者首次就诊时医生级别有较高的相对危险度，其OR值分别为3.059和2.778 （P<0.01）；激素使用史的危险度较低，OR=0.387（P<0.05）。其他疾病被误诊为股骨头坏死Logistic回归分析显示，患者首次就诊时医生级别有较高的相对危险度，其OR值为3.573（P<0.01）。
结论：股骨头坏死误诊率较高，隐匿起病和患者首次就诊时的低级别医生是股骨头坏死被误诊为其他疾病较高的相对危险因素，而激素使用史则是误诊的保护性因素；患者首次就诊时的低级别医生是其他疾病被误诊为股骨头坏死较高的相对危险因素。 |
| 【关键词】股骨头坏死 误诊 危险因素 Logistic回归分析 |
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| Study on the risk factors for the misdiagnosis of femoral head osteonecrosis |
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ABSTRACT
Objective: To evaluate the status and risk factors for the misdiagnosis of femoral head osteonecrosis,providing the basis for accurate diagnosis of osteonecrosis of femoral head.
Methods: The data of 314 hospitalized patients were collected from March 2015 to March 2016,and the risk factors for osteonecrosis of femoral head were analyzed by Logistic regression model. Misdiagnosis was defined that the diagnosis given on the first time was different from that on the second time or that given by expert group with the same symptoms and signs. The general data,predisposing factors,time of onset,hospital visits,clinical manifestations,X-ray film of hip joint,MRI and other data were statistically analyzed.
Results: Total 127 patients experienced misdiagnosis (up to 40.8%). Among them,the patients with osteonecrosis of femoral head misdiagnosed as other diseases accounted for 77.2% and the patients with other diseases misdiagnosed osteonecrosis of femoral head accounted for 22.8%. Statistical analysis showed that the predisposing factors,history of glucocorticoid and alcohol intake,diseased lower limb,pained lower limb,hidden disease attack,the level of first reception hospital and expert were significantly related with the misdiagnosis of femoral head osteonecrosis based on the logistic regression model (P<0.05). The relationship between misdiagnosis and gender,age,primary disease taking glucocorticoid,approach and time of glucocorticoid use,the type of alcohol,drinking time had no statistical significance(P>0.05). The Logistic regression analysis showed that the hidden disease attack(OR=3.059) and level of first reception expert(OR=2.778) were the high risk factors associated with the misdiagnosis in which the femoral head necrosis was misdiagnosed as other diseases(P<0.01),and glucocorticoid intake history was the low risk factors(OR=0.387)(P<0.05). The Logistic regression analysis showed that the level of first reception expert (OR=3.573) was the high risk factor associated with the misdiagnosis in which the other diseases were misdiagnosed as necrosis of femoral head.
Conclusion: Misdiagnosis rate of femoral head necrosis is high. Hidden disease attack and low level of first reception expert are the high risk factors associated with the misdiagnosis in which the femoral head necrosis was misdiagnosed as other diseases,however,glucocorticoid intake history is the protective factor of misdiagnosis. Low level of first reception expert is the high risk factor associated with the misdiagnosis in which other diseases were misdiagnosed as necrosis of femoral head. |
| KEY WORDS Femur head necrosis Diagnostic errors Risk factors Logistic regression analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈志伟,李泰贤,万晓旭,王荣田,陈卫衡.股骨头坏死误诊相关因素研究[J].中国骨伤,2017,30(11):1000~1003 |
| 英文格式: | CHEN Zhi-wei,LI Tai-xian,WAN Xiao-xu,WANG Rong-tian,CHEN Wei-heng.Study on the risk factors for the misdiagnosis of femoral head osteonecrosis[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(11):1000~1003 |
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