[Study on the risk factors for the misdiagnosis of femoral head osteonecrosis].

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 (<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(>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(<0.01), and glucocorticoid intake history was the low risk factors(OR=0.387)(<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.

Conclusions: 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.