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[目的]通过对儿童股骨头坏死发病特点、中药多途径治疗、影响因素及误诊相关因素的回顾性研究,明确发病特征、诊断影响因素及中药多途径治疗的临床疗效。[方法]调查随访本院2003～2011年接受中药多途径治疗的儿童股骨头骨骺坏死30例(33髋),Catterall分期Ⅰ期0髋,Ⅱ期4髋,Ⅲ期16髋,Ⅳ期13髋。收集治疗前后X线和临床材料,进行总结分析,根据CE角及头臼圆心距进行疗效判定。[结果]治疗后末次随访CE角(23.77±6.32)°,头臼圆心距(2.44±2.34)mm。有被动吸烟史与无被动吸烟史、患儿父母有酗酒史与无酗酒史、有外伤史与无外伤史的患儿发病年龄有统计学意义(P<0.05)。26%的患者出现症状后选择二级医院就诊,其误诊率为66%,74%的患者出现症状后选择三级医院就诊,其误诊率为10%。患髋活动受限的患者误诊率高于患髋活动正常的患者;首诊医院为二级医院的患者误诊率高。[结论](1)中药多途径治疗可以促进骨骺发育,改善股骨头形态,恢复髋臼覆盖,并避免手术创伤;(2)首诊医院的级别、发病部位、患髋活动情况为导致误诊出现的重要影响因素;(3)无被动吸烟史、父母无酗酒史、无外伤史的患儿预后较好。
[Objective] The purpose of this study was to retrospectively study the characteristics of children’s femoral head necrosis, multi-pathological treatment of Chinese medicine, influencing factors and related factors of misdiagnosis, to clarify the characteristics of the disease, the influencing factors of diagnosis and the clinical efficacy of multi-path Chinese medicine treatment. [Methods] Thirty cases (33 hips) of epiphyseal necrosis of femoral head were treated in our hospital from 2003 to 2011. There were 0 hips in stage Ⅰ, 4 hips in stage Ⅱ, 16 hips in stage Ⅲ, 13 hips in stage Ⅳ . Before and after treatment to collect X-ray and clinical materials, to carry out a summary analysis, according to the CE angle and the head mortar center to determine the efficacy. [Results] The final follow-up CE angle (23.77 ± 6.32) ° after treatment, and the center distance of the head mortar (2.44 ± 2.34) mm. There is a history of passive smoking and no passive smoking history, children with alcoholism and alcohol abuse parents history, history of trauma and no history of trauma history of children with a statistically significant age (P <0.05). Twenty-six percent of patients selected secondary hospitals after symptom onset, with a misdiagnosis rate of 66%. In 74% of patients, tertiary care was selected after symptom onset and the misdiagnosis rate was 10%. The misdiagnosis rate of patients with limited hip activity is higher than that of patients with normal hip activity. The misdiagnosis rate of patients who are first-class hospitals in second-class hospitals is high. [Conclusion] (1) Multi-pathway treatment of traditional Chinese medicine can promote the development of epiphyseal, improve the shape of femoral head, restore the coverage of acetabulum and avoid the surgical trauma. (2) The grade, the site of attack and the activity of hip in first- (3) Children with no history of passive smoking, no alcoholism and no history of trauma had good prognosis.