原位骨软骨移植治疗股骨头压缩性骨折一例报告

Orthotopic osteochondral transplantation for the treatment of femoral head compression fracture:a case report and literature review

股骨头骨折常见于高能量损伤,其中压缩性骨折更为少见,常用骨折分型中较少提及。报告1例急性创伤性髋关节脱位伴股骨头压缩性骨折病例。患者骑电动车撞击花坛致伤,右下肢疼痛、活动受限就诊。经过病史、体格检查和影像学检查确诊为右侧髋关节前脱位伴股骨头压缩性骨折。急诊行髋关节脱位闭合复位。再采用外科脱位技术(即Ganz入路),取股骨头下非负重区骨软骨块移植至塌陷负重区,应用全螺纹无头钉埋头固定;另取自体髂骨重建非负重供区。术中成功获得股骨头解剖结构复位;术后3个月X线片示股骨头光滑、移植骨软骨块固定良好;术后8个月患者根据自身情况逐步由部分负重增至全部负重,髋关节无明显疼痛;术后24个月X线片示股骨头骨折复位固定良好,CT示股骨头无坏死、囊性变,患者髋关节被动、主动活动良好,负重行走无疼痛。对髋关节脱位伴股骨头压缩性骨折患者,尽早关节复位、非负重区骨软骨移植可恢复股骨头负重区的解剖结构,避免创伤性骨关节炎发生,提高患者远期生活质量。

Femoral head fracture is commonly seen in high-energy injury.However,compression fracture of femoral head is more rare.In most classifications of femoral head fracture,the compression is unusually involved.A case about acute traumatic dislocation of hip joint with compression fracture of femoral head is reported,involving a patient who hurt himself by riding electric bike and hitting the flower bed.He came to our hospital complaining of pain and limited motion of his right leg.The diagnosis of right hip anterior dislocation with the compression fracture of femoral head was confirmed by medical history,physical examination and imaging.Closed reduction of hip dislocation was performed in an emergency.Then we transplanted the bone cartilage from the non-weight-bearing area under the femoral head to the collapsed weight-bearing area,fixing it with countersunk hollow screws,and then the non-weight-bearing donor area was reconstructed with autogenous iliac bone,using surgical hip dislocation.The anatomical structure of the femoral head was therefore restored successfully during the operation.Three months after surgery,the X-ray showed that the femoral head was smooth and the cartilage graft was well fixed.Eight months after surgery,the patient gradually increased the bearing weight from partial to full according to his own condition,and there was no obvious pain in hip.After 24-month follow-up,we found the X-rays showed good reduction and fixation of the femoral head fracture.The CT scan showed no necrosis or cystic degeneration.He got well-active and passive movement in hip joint,and got no pain when walking with burden.For the patient with hip dislocation and compression fracture of femoral head,early joint reduction and non-weight-bearing osteocartilage transplantation can restore the anatomical structure of the weight-bearing area of the femoral head,to avoid traumatic osteoarthritis,and to improve the long-term quality of life of patients.