股骨头软骨下应力性骨折5例报告及文献复习

Subchondral insufficiency fracture of the femoral head:five cases report and literature review

目的:描述股骨头软骨下应力性骨折的临床特点。方法:中日友好医院骨科2009年～2010年,共发现股骨头软骨下应力性骨折患者5例7髋,其中男2例,女3例,年龄20～73岁,主诉均为腹股沟区机械性疼痛。1例为原发性骨质疏松,2例为应用激素继发骨质疏松,1例为股骨干骨折后废用性骨质疏松,另1例为经高强度训练的新兵。磁共振成像(MRI)检查发现,T1、T2相均有股骨头下低信号线,围绕以T1低信号、T2高信号区域。结果:对5例6髋行免负重、对症药物治疗6周,1例1髋行经股骨大转子旋转截骨术。平均随访23个月(13～37个月)。患者恢复良好。结论:骨量不足是股骨头软骨下应力性骨折的危险因素,MRI可确诊。治疗首选保守治疗,严重者可手术治疗。

Objective：To describe the features of subchondral insufficiency fracture of the femoral head.Methods：Five cases,2 males and 3 females,with seven hips of subchondral insufficiency fracture of the femoral head were found between 2009 and 2010 in the Hospital.The age ranged from 20 to 73.Their main complaint was mechanic groin pain.One patient had primary osteoporosis.Three cases had secondary osteoporosis because of steroid and femoral fracture,respectively.The last one was a military recruit.Magnetic resonance imaging（MRI）showed a hypo-intensity line on both T1-and T2-weighted images in the subchondral region,surrounded by an area of hypo-intensity on T1-weighted image and hyper-intensity on T2-weighted image.Results：Five cases with six hips were treated by bearing-free and durgs.Transtrochanteric rotational osteotomy was performed to one hip.All patients recovered well after a mean follow-up period of 23 months.Conclusion：Osteopenia is the risk factor of subchondral insufficiency fracture of the femoral head.MRI could be used to confirm the diagnosis.It should first take a conservative treatment.Only serious cases need an operation.