Shin AY, Gillingham BL
Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, Calif.
J Am Acad Orthop Surg. 1997 Nov;5(6):293-302. doi: 10.5435/00124635-199711000-00001.
Fatigue fractures of the femoral neck are potentially disabling injuries if the diagnosis is missed or delayed and proper treatment is not provided. Previously considered primarily an injury of military personnel, femoral-neck fatigue fractures are becoming increasingly more common among nonmilitary athletes. The pathogenesis of this condition is multifactorial. Ultimately, fracture is thought to be caused by repetitive submaximal stresses that occur with a frequency that exceeds the adaptive ability of the bone. The clinical hallmark of a femoral-neck fatigue fracture in an impact-loading athlete is nonspecific, activity-related hip pain that is relieved by rest. Plain radiographs obtained initially are often negative. Radionuclide imaging is useful but not specific. Magnetic resonance imaging has demonstrated better specificity, sensitivity, and accuracy than are available with other modalities in the diagnosis of this injury. Treatment of compression-side injuries is generally conservative. Treatment of tension-side injuries remains controversial. The authors recommend aggressive treatment of tension-side injuries to prevent the potentially catastrophic sequelae of displacement, which include osteonecrosis, malunion, and coxarthrosis.
如果漏诊或延误诊断且未给予恰当治疗，股骨颈疲劳性骨折可能导致残疾。股骨颈疲劳性骨折以前主要被认为是军事人员的损伤，现在在非军事运动员中越来越常见。这种情况的发病机制是多因素的。最终，骨折被认为是由反复的次最大应力引起的，其发生频率超过了骨骼的适应能力。在冲击负荷运动员中，股骨颈疲劳性骨折的临床特征是非特异性的、与活动相关的髋部疼痛，休息后可缓解。最初获得的X线平片通常为阴性。放射性核素成像有用但不具有特异性。在诊断这种损伤方面，磁共振成像已显示出比其他检查方法更好的特异性、敏感性和准确性。压缩侧损伤的治疗一般是保守的。张力侧损伤的治疗仍存在争议。作者建议积极治疗张力侧损伤，以防止移位可能带来的灾难性后果，包括骨坏死、畸形愈合和髋关节炎。
