Min B W, Koo K H, Song H R, Cho S H, Kim S Y, Kim Y M, Kang C S
Department of Orthopedic Surgery, Keimyung University School of Medicine, Taegu, South Korea.
Clin Orthop Relat Res. 2001 Sep(390):227-31. doi: 10.1097/00003086-200109000-00026.
The authors reviewed 10 patients with subcapital fractures associated with extensive osteonecrosis of the femoral head and distinguished these fractures from traumatic femoral neck fractures The mean age of the patients was 52 years (range, 36-68 years). Nine patients were younger than 60 years. Eight patients had risk factors for osteonecrosis. Necrosis was extensive and involved nearly the whole femoral head. Fracture occurred at the junction between a necrotic bone and reparative bone and extended downward through the reparative interface to the healthy inferior cortex of the femoral neck. Patients experienced hip pain that was aggravated gradually during a period of 1 to 24 weeks before diagnosis of the fracture. In all patients, the opposite femoral head was involved with osteonecrosis. In two femoral heads, slight collapse or subchondral fracture (crescent sign) also was observed. No patient had a history of precipitating trauma. In patients younger than 60 years with a subcapital fracture, fracture associated with extensive osteonecrosis of the femoral head should be suspected when a history of trauma is not obvious, when the opposite hip shows findings of osteonecrosis, and when the patient has a risk factor of osteonecrosis. In these fractures, osteosynthesis rarely should be considered because of the high failure rate caused by additional progression of extensive osteonecrosis and the probability of nonunion.
作者回顾了10例伴有股骨头广泛骨坏死的股骨头下骨折患者，并将这些骨折与创伤性股骨颈骨折区分开来。患者的平均年龄为52岁（范围36 - 68岁）。9例患者年龄小于60岁。8例患者有骨坏死的危险因素。坏死范围广泛，几乎累及整个股骨头。骨折发生在坏死骨与修复骨的交界处，并向下延伸穿过修复界面至股骨颈健康的下皮质。患者在骨折诊断前1至24周期间逐渐出现髋部疼痛并加重。所有患者对侧股骨头均有骨坏死。在两个股骨头中，还观察到轻微塌陷或软骨下骨折（新月征）。没有患者有明显的外伤史。对于年龄小于60岁的股骨头下骨折患者，当外伤史不明显、对侧髋关节有骨坏死表现且患者有骨坏死危险因素时，应怀疑为伴有股骨头广泛骨坏死的骨折。对于这些骨折，由于广泛骨坏死的进一步发展导致的高失败率和骨不连的可能性，很少应考虑进行骨内固定。
