Subchondral Insufficiency Fracture of the Femoral Head in a Pregnant Woman with Pre-existing Anorexia Nervosa
Subchondral Insufficiency Fracture of the Femoral Head in a Pregnant Woman with Pre-existing Anorexia Nervosa
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DOI：
10.1620/tjem.245.1
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发表时间：
2018-05-01
影响因子：
2.2
通讯作者：
Murakami, Takashi
中科院分区：
文献类型：
--
作者：
Kasahara, Kyoko;Mimura, Tomohiro;Murakami, Takashi
软骨下功能不全骨折（SIF）是继发于骨质疏松症的脆性骨折，导致股骨头塌陷，但无骨坏死迹象。股骨头SIF在不同年龄和性别的成年人中均有报道，但从未报道发生在孕妇中。在此，我们描述了一个40岁的产妇病人与预先存在的神经性厌食症谁开发的股骨头SIF在第三个三月。妊娠29周时，患者主诉行走时双髋突然疼痛。尽管卧床休息，但她的髋关节疼痛加剧;因此，在36周时进行了剖宫产。分娩后，平片显示左侧股骨头塌陷。双能X线骨密度测定法显示患者为骨质疏松。她的髋关节磁共振成像（MRI）显示与SIF一致的结果。她的左髋疼痛在随访期间恶化，X线片显示左股骨头进行性塌陷。患者在分娩后18个月接受左侧双极髋关节置换术，组织病理学诊断为SIF。这是第一个报告的SIF在孕妇，可能反映了妊娠相关的骨质疏松症。妊娠期SIF可能被忽视或误诊，因为MRI表现与其他髋关节疾病有一些重叠。妊娠期SIF的准确诊断可能有助于避免年轻女性的早期关节成形术和适当评估患者的骨质减少状态，从而获得更好的结局。
Subchondral insufficiency fracture (SIF) is a fragility fracture secondary to osteoporosis that leads to collapse of the femoral head with no evidence of osteonecrosis. SIF of the femoral head has been reported in adults of varying ages and both sexes, but it has never been reported to occur in pregnant women. Herein, we describe a 40-year-old primiparous patient with pre-existing anorexia nervosa who developed SIF of the femoral head in the third trimester. At 29 weeks of gestation, the patient complained of sudden pain on walking in both hips. Despite the bed rest, her hip pain increased; consequently, cesarean section was performed at 36 weeks. After delivery, plain radiographs showed that the left femoral head was collapsed. Dual-energy X-ray absorptiometry indicated that the patient was osteoporotic. The magnetic resonance imaging (MRI) of her hips showed the findings that were compatible with SIF. Her left hip pain worsened during follow-up, and a radiograph showed progressive collapse of the left femoral head. The patient then underwent left bipolar hip arthroplasty 18 months after delivery, and she was diagnosed with SIF histopathologically. This is the first report of SIF in a pregnant woman that may reflect pregnancy-associated osteoporosis. SIF in pregnancy might be overlooked or misdiagnosed because the MRI findings have several overlaps with those of other hip disorders. Precise diagnosis of SIF in pregnancy may contribute to a better outcome by avoiding early arthroplasty in young women and appropriate evaluation of the osteopenic status of the patient.