Anterior femoroacetabular impingement after femoral neck fractures
Anterior femoroacetabular impingement after femoral neck fractures
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DOI：
10.1097/00005131-200109000-00003
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发表时间：
2001-09-01
影响因子：
2.3
通讯作者：
Ganz, R
中科院分区：
文献类型：
--
作者：
Eijer, H;Myers, SR;Ganz, R
目的：验证股骨髋臼前撞击是否可能是股骨颈骨折愈合患者髋部疼痛和活动能力丧失的原因。设计：回顾性临床、放射学和外科评估。单位：第三转诊医院。患者：在1995年至1999年间，9名患者因髋部疼痛和活动能力丧失而接受了股骨颈骨折治疗。这些患者大多为年轻患者（平均年龄33.3岁），主诉腹股沟疼痛。体格检查时，在屈曲、内收和内旋时，被动地将股骨颈压在髋臼缘上可引起急性疼痛，这些运动都受到限制。方法：对股骨头半脱位或股骨头脱位手术后的患者进行常规x线片和关节成像磁共振成像扫描，分析股髋臼前撞击的后遗症。治疗的基础是改善前偏移（头部前轮廓与股骨颈之间的差异）或转子间截骨以改善关节间隙。结果：术中8例患者（1例未手术）均发现因骨折复位不足引起的撞击，在常规x线片上已可见。所有患者头部后旋（平均20度）引起前撞击，2例患者头部额外内翻位置（平均头柱夹角115度）引起前外侧撞击。在所有患者中，在手术股骨头半脱位或脱位期间发现了前唇和邻近的髋臼软骨病变，与磁共振成像扫描所见的情况相当。它们被证明是由头颈交界处和髋臼之间的重复基台和压迫引起的。结论：股骨髋臼撞击可能是先前股骨颈骨折患者髋部疼痛和活动丧失的原因。这种情况会导致前唇和相邻的髋臼软骨退行性损伤。早期治疗对于防止进一步的退变和关节骨关节病至关重要。预防的前提是在所有平面上对此类骨折进行初始精确解剖复位。
Objectives: To verify whether anterior femoroacetabular impingement can be a reason for hip pain and loss of motion in patients with a healed femoral neck fracture,Design: Retrospective clinical, radiologic, and surgical evaluation.Setting: Third referral hospital.Patients: Nine patients who previously sustained a femoral neck fracture were treated between 1995 and 1999 for hip pain and loss of motion. All these mostly young patients (mean age 33.3 years) complained of groin pain. During the physical examination, acute pain could be elicited by passively forcing the femoral neck against the acetabular rim in flexion, adduction, and internal rotation, motions that were all limited.Methods: Conventional radiographs and, if possible, arthrographic magnetic resonance imaging scans were followed by a surgical subluxation or dislocation of the femoral head to analyze the sequelae of anterior femoroacetabular impingement. Treatment was based on improvement of the anterior offset (the difference between the anterior contour of the head and the femoral neck) or intertrochanteric osteotomy to ameliorate clearance of the joint.Results: Intraoperatively in eight patients (one not operated), impingement was found to result from insufficient reduction of the fracture, already visible on the conventional radiographs. Retrotorsion (mean 20 degrees) of the head caused anterior impingement in all patients, additional varus position (mean caput collum diaphysis angle 115 degrees) of the head caused anterolateral impingement in two patients. In all patients, anterior labral and adjacent acetabular cartilage lesions were found during surgical subluxation or dislocation of the femoral head, comparable to those seen on the magnetic resonance imaging scan. They proved to result from repetitive abutment and compression between the head-neck junction and the acetabulum.Conclusion: Femoroacetabular impingement can be a cause for hip pain and loss of motion in patients who previously sustained a femoral neck fracture. The condition causes degenerative anterior labral and adjacent acetabular cartilage lesions. Early treatment is essential to prevent further degeneration and osteoarthrosis of the joint. Prevention is predicated by initial precise anatomic reduction of such fractures in all planes.