髋关节后脱位合并股骨头骨折手法复位致股骨颈骨折1例

患者,男,24岁,煤矿工人,既往体健。2005年5月26日下午5时在煤矿劳动时被矿车撞伤右髋部,局部疼痛、畸形、活动受限2h入院。查体:T37℃,P82次/min,R18次/min,BP18/12kPa。神志清醒,痛苦貌,心肺腹检查无异常,骨盆挤压分离试验右腹股沟处疼痛,右髋关节呈内收、内旋、屈曲畸形,弹性     

半髋关节置换术改善老年股骨颈骨折患者髋关节功能的效果观察

目的：观察半髋关节置换术改善老年（年龄≥60岁）股骨颈骨折患者髋关节功能的效果。方法随机将105例老年股骨颈骨折患者进行分组,半髋组行半髋关节置换术,全髋组行全髋关节置换术,观察手术指标和改善髋关节功能效果。结果半髋组手术时间、术中出血量和术后引流量少于全髋组（P＜0.01）;髋臼外展角和髋臼前倾角优于全髋组（P＜0.01）;髋关节功能优良率94.23%高于对照组77.36%（P＜0.05）;并发症发生率5.77%略低于全髋组15.09%（P＞0.05）。结论半髋关节置换术改善老年股骨颈骨折患者髋关节功能效果确切,能够缩短手术时间、降低术中出血量以降低手术风险,维持股骨颈假体位置,促进髋关节功能恢复和降低手术并发症。     

Posterior dislocation of the hip joint with fracture of both the femoral head and neck

Fracture of both the femoral head and neck associated with posterior hip dislocation is a rare injury. This report describes a rare case of fracture-dislocation of the hip joint with a separated femoral head with a residual fragment in the acetabulum, and a subcapital fracture. We performed open reduction with internal fixation immediately after the injury. Osteonecrosis of the femoral head was detected one year after the surgery, however this patient had no symptoms related to the hip joint.     

Fracture-dislocation of the hip with ipsilateral femoral neck fracture

. Fracture-dislocation of the hip associated with fracture of the femoral neck and intrapelvic intrusion of the femoral head is a rare injury. In this case we performed open reduction for the femoral neck fracture, and external fixation for the pelvic fracture by Judet-Meyers method. As a result the patient has not complained of pain, although he developed arthrokleisis due to ectopic ossification around the femoral head, as well as femoral head necrosis. Résumé. Nous rapportons un cas de fracture-luxation de la tête fémorale avec migration dans le bassin chez un homme de 25 ans. La réduction a été réalisée par fixation vis-plaque, le patient ne présente actuellement aucune douleur, pas d'arthrose de la hanche, ni de nécrose de la tête fémorale, mais il a une petite raideur due à des ossifications péri-articulaires de sa hanche. Cinq ans après, le patient est resté asymptomatique.     

Sclerostin and the regulation of bone formation: Effects in hip osteoarthritis and femoral neck fracture

Remodeling imbalance in the elderly femoral neck can result in thin cortices and porosity predisposing to hip fracture. Hip osteoarthritis protects against intracapsular hip fracture. By secreting sclerostin, osteocytes may inhibit Wnt signaling and reduce bone formation by osteoblasts. We hypothesised that differences in osteocytic sclerostin expression might account for differences in osteonal bone‐formation activity between controls and subjects with hip fracture or hip osteoarthritis. Using specific antibody staining, we determined the osteocytic expression of sclerostin within osteons of the femoral neck cortex in bone removed from subjects undergoing surgery for hip osteoarthritis (hOA: 5 males, 5 females, 49 to 92 years of age) or hip fracture fixation (FNF: 5 males, 5 females, 73 to 87 years of age) and controls (C: 5 males, 6 females, 61 to 90 years of age). Sclerostin expression and distances of each osteocyte to the canal surface and cement line were assessed for all osteonal osteocytes in 636 unremodeled osteons chosen from fields (～0.5 mm in diameter) with at least one canal staining for alkaline phosphatase (ALP), a marker of bone formation. In adjacent sections, ALP staining was used to classify basic multicellular unit (BMUs) as quiescent or actively forming bone (ALP⁺). The areal densities of scl^? and scl⁺ osteocytes (number of cells per unit area) in the BMU were inversely correlated and were strong determinants of ALP status in the BMU. In controls and hip fracture patients only, sclerostin‐negative osteocytes were closer to osteonal surfaces than positively stained cells. Osteon maturity (progress to closure) was strongly associated with the proportion of osteonal osteocytes expressing sclerostin, and sclerostin expression was the chief determinant of ALP status. hOA patients had 18% fewer osteocytes per unit bone area than controls, fewer osteocytes expressed sclerostin on average than in controls, but wide variation was seen between subjects. Thus, in most hOA patients, there was increased osteonal ALP staining and reduced sclerostin staining of osteocytes. In FNF patients, newly forming osteons were similar in this respect to hOA osteons, but with closure, there was a much sharper reduction in ALP staining that was only partly accounted for by the increased proportions of osteonal osteocytes staining positive for sclerostin. There was no evidence for a greater effect on ALP expression by osteocytes near the osteonal canal. In line with data from blocking antibody experiments, osteonal sclerostin appears to be a strong determinant of whether osteoblasts actively produce bone. In hOA, reduced sclerostin expression likely mediates increased osteoblastic activity in the intracapsular cortex. In FNF, full osteonal closure is postponed, with increased porosity, in part because the proportion of osteocytes expressing sclerostin increases sharply with osteonal maturation. © 2010 American Society for Bone and Mineral Research     

股骨近端缩短及全髋置换术治疗陈旧股骨颈骨折伴严重髋关节脱位

目的 探讨陈旧股骨颈骨折伴严重髋关节脱位的有效治疗方法及临床疗效。方法 自1996年4月采用股骨近端缩短及全髋置换术治疗7例陈旧股骨颈骨折伴严重的髋关节脱位的患者。结果 7例患者平均为51岁,术后随访平均为27．3个月,在近期随访过程中,按Harris评分由手术前的36．7分增加至术后84．3分,髋臼及股骨柄假体位置良好,未出现假体松动和下沉,也未出现截骨处骨不愈合。结论 股骨近端缩短及全髋置换术治疗陈旧股骨颈骨折伴严重髋关节脱位,近期疗效十分满意,其后期疗效有待进一步随访观察。     

老年人股骨颈骨折髋关节置换疗效分析

目的 :评价老年人股骨颈骨折髋关节置换临床疗效 ,探讨有关假体选择、并发症、手术时机把握等问题。方法 :回顾分析 1995～ 2 0 0 2年收治的 62例 70岁以上老年人股骨颈骨折应用髋关节置换的治疗方法及效果。结果 :随访 2 2～ 96个月 ,按照Harris[1] 评分标准进行评估显示 ,本组优良率为 83 .9%。全髋置换组明显优于半髋组 ,优良率为 93 .9% ,半髋组则为 46.2 %。结论 :(1)在并存症得到控制稳定后 ,及时地根据病人伤前生活质量来选择全髋或半髋置换是治疗高龄股骨颈骨折的首选方法 ;(2 )强调术中注意观察及处理麻醉开始、扩髓与灌注骨水泥这三个时段病情的变化 ;(3 )陈旧性股骨颈骨折病人术前不适宜牵引。     

骨质疏松女性股骨颈骨折与股骨转子间骨折的髋部骨密度差异分析

目的明确骨质疏松女性股骨颈骨折与股骨转子间骨折的髋部骨密度差异,探讨骨质疏松患者发生髋部骨折(股骨颈骨折、股骨转子间骨折)与骨折部位骨密度的相关性。方法回顾性分析2015年1月1日至2016年12月31日期间于福建省某三级甲等医院的住院治疗的骨质疏松及髋部骨质疏松性骨折患者172例,其中无病史的原发骨质疏松患者109例、骨质疏松性股骨颈骨折患者39例、骨质疏松性转子间骨折24例。分别统计3组患者年龄、体质指数、糖尿病患病情况、骨折侧别、髋部各部位骨密度、血清Ⅰ型胶原交联C末端肽(C-terminal crosslinking telopeptide of type Ⅰ collagen,CTX)、Ⅰ型原胶原N-端前肽(procollagen type ⅠN propeptide,PINP)、25羟基维生素D(25-OH-D)。分别进行三组间及两两组间比较。结果三组间年龄、体质指数、糖尿病患病率差异无统计学意义(F=2.667,P=0.072; F=0.882,P=0.416;χ~2=3.216,P=0.232),股骨颈骨折组与股骨转子间骨折组组间骨折侧别差异无统计学意义(χ~2=0.958,P=0.328),三组间髋部Ward区骨密度差异无统计学意义(F=2.937,P=0.056),髋部骨密度比较,股骨颈、股骨大转子、股骨转子间、髋部整体差异有统计学意义(F=7.825,P=0.001; F=8.668,P0.001; F=9.657,P0.001)。股骨颈骨折组、转子间骨折组股骨颈、股骨大转子、股骨转子间、髋部整体骨密度均小于骨质疏松组,差异均有统计学意义(P0.05);股骨颈骨折组与转子间骨折组股骨颈、大转子、转子间、髋部整体骨密度差异均无统计学意义(P0.05)。三组间β-CTX、P1NP、维生素D差异均有统计学意义(P0.05)。股骨颈骨折组、转子间骨折组β-CTX、维生素D均小于骨质疏松组,差异均有统计学意义(P0.05);转子间骨折与骨质疏松组P1NP差异无统计学意义,股骨颈骨折组与转子间骨折组股骨颈、大转子、转子间、髋部整体骨密度差异均无统计学意义(P0.05)。结论女性骨质疏松患者发生髋部骨折的类型可能并不取决局部的骨密度,可能与骨微结构等因素相关,要得到明确、可靠的结果仍需进一步研究证实。     

Age trends for hip geometry in Chinese men and women and the association with femoral neck fracture

Summary  

Hip dual-energy X-ray absorptiometry (DXA) images were used to calculate hip bone mineral density (BMD) and hip geometry parameters of 18,502 healthy Chinese people (14,435 women and 4,067 men), 254 subjects sustained a femoral neck fracture and 254 age- and sex-matched controls. Our study showed that thinning of the cortical shell and deterioration of the strength index (SI) in femoral neck with aging in both Chinese men and women. SI may be a risk factor for hip fracture in Chinese women.     

偏心距重建对股骨颈骨折关节置换术后恢复的影响

目的 探讨股骨颈骨折行人工关节置换术重建股骨偏心距(FO)对患者髋关节功能Harris评分及髋关节活动度的影响.方法 2004年2月至2005年10月对47例单侧股骨颈骨折行人工髋关节置换术的患者进行随访.随访时摄X线片测量,对比患侧与健侧FO.分析术后FO与患肢髋关节Harris评分及髋关节活动范围的相关性,对全髋关节置换术和人工双极头置换术的FO重建率进行χ2检验.结果 FO绝对值大小与患侧髋关节功能Harris评分高低尢相关关系(r=0.23,P=0.1 18),是否进行FO重建在髋关节功能Harris评分方面差异有统计学意义(t=7.25,P＜0.001)髋关节外展范围与FO存在明显正相关性(r=0.80,P＜0.001),全髋置换术及人工双极头置换术的FO重建率差异无统计学意义(χ2=0.13,P＞0.05).结论 股骨颈骨折人工髋关节置换术中重建FO有助于术后髋关节功能的恢复.FO的重建能影响髋关节的外展范围,但与术式选择(全髋置换术或人工双极头置换术)无关.     

Posterior dislocation of the hip with ipsilateral displaced femoral neck fracture

Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or preserving the femoral head. We presented a case of young adult with such an injury. He was operated upon with reduction of the dislocation and fixation of femoral neck fracture with the help of cancellous screws. Two years later, the fracture had united and the patient was asymptomatic. We further proposed the mechanism of injury for such a fracture and discussed the management in the changing trauma scenario of the developing world.     

髋部骨折患者中股骨颈强度的测定

目的：了解老年髋部骨折和老年骨质疏松的关系。方法：选择1998年至2003年收治的50岁以上老年髋部骨折80例,测定其健侧股骨上端强度（Singh指数）,同时选择门诊50岁以上其他原因摄骨盆X线片而无骨盆和股骨上端骨折的患者90例,测定其左侧股骨上端强度,将测得的数值作对比分析。结果：50～60岁组和61～70岁组股骨上端强度与对照组比较差异有统计学意义（P〈0.01）,而70岁以上组的强度与对照组比较差异无统计学意义（P〉0.05）。结论：老年髋部骨折患者其股骨上端强度明显下降,测定Singh指数对预测髋部骨折有重要意义。     

老年人营养状况对股骨颈骨折术前隐性失血的影响

[目的]明确老年股骨颈骨折患者入院时营养状况对术前隐性失血的影响。[方法]纳入345例获得完整随访的股骨颈骨折患者进行分析,平均年龄77.71岁,均为新鲜初次股骨颈骨折;根据MNA评分分为营养正常组、潜在营养不良组和营养不良组,根据身高、体重、入院时和术前红细胞压积,计算术前血容量和隐性失血量,按照术前隐性失血量占术前血容量比例将患者分为低和高隐性失血量组。比较两组间术前隐性失血量及其占术前血容量的比例和术前高隐性失血发生率是否有差异,分析术前营养状况与术前高隐性失血之间的关系。[结果]共90例患者发生高隐性失血,术前隐性失血量平均166.40 ml,术前隐性失血量占术前血容量的平均比例为4.04%。其中营养正常组术前隐性失血量及其占术前血容量的比例分别为120.10 ml和2.87%,高隐性失血发生率为14.13%(13/92例);潜在营养不良组为158.98 ml和3.86%,高隐性失血发生率为25.62%(31/121例);营养不良组为200.41 ml和4.92%,高隐性失血发生率为34.85%(46/132例)。营养不良和潜在营养不良患者术前隐性失血量及其占术前血容量比例和高隐性失血发生率均明显高于营养正常患者,各分组两两间比较,差异均有统计学意义(P0.05)。[结论]老年股骨颈骨折患者术前隐性失血量及其占术前血容量的比例和高隐性失血发生率均随着营养状况的恶化而逐渐升高;营养状况是术前隐性失血发生的重要影响因素,可作为判断高隐性失血和预后的重要指标。     

Anterior dislocation of hip with ipsilateral femoral neck and head fracture

A 70-year-old male patient presented to our emergency department with trauma left hip following a fall. Physical examination revealed external rotation, slight flexion, adduction, and shortening of the affected limb. There was a palpable fullness in the groin. Radiographic examination revealed fracture neck of femur with femoral head dislocated anteriorly and lying in the obturator foramen. There was an associated femoral head fracture with a fragment of it in the acetabulum. Although this sort of injury has been reported once, the difference in our case lies in the age of the patient; the injury complex was caused by a less severe trauma and a unique mechanism of injury. Also a modification of Brumback classification is proposed to include such fractures more specifically in order to allow comparative analysis in such rare injuries as more and more such case reports are added to literature.     

全髋与半髋关节置换术治疗股骨颈骨折

2015年3月~2016年2月,我科行全髋与半髋关节置换术治疗36例股骨颈骨折患者,临床效果满意,报道如下。1材料与方法1.1病例资料本组共36例,男19例,女17例,年龄62~78(68.46±3.69)岁。全髋置换20例,半髋置换16例。骨折Garden分型:Ⅲ型29例,Ⅳ型7例。受伤至手术时间2~5 d。1.2治疗方法硬膜外麻醉下手术。患者侧卧位。按髋关节后外侧切口入路,切开皮肤及阔筋膜,离断部分臀中肌和外旋肌群,充分暴露股骨颈后进行不同术式的髋关节置换。1.2.1半髋关节置换术电摆锯在股骨颈处截骨,保留股骨小转子上沿1.5 cm长度的股骨颈,将股骨头取出后测量最大直径,选用配套股骨头假体备用。扩髓器对股骨端进行扩髓,冲洗髓腔,放置股骨远端塞至假体柄远端2 cm处,调制骨水泥至拉丝状,打入股骨髓腔后装配股骨柄假体,至骨水泥完全硬化后安上股骨柄双极头假体,复位髋关节后未见松动及脱位,放置引流管后逐层关闭切口。术后1 d拔除引流管。