Eijer H, Myers S R, Ganz R
Department of Orthopaedics, University Hospital, Inselspital, Bern, Switzerland.
J Orthop Trauma. 2001 Sep-Oct;15(7):475-81. doi: 10.1097/00005131-200109000-00003.
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.
Retrospective clinical, radiologic, and surgical evaluation.
Third referral hospital.
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.
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.
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.
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.
验证股骨髋臼前撞击症是否可能是股骨颈骨折愈合患者髋关节疼痛和活动受限的原因。
回顾性临床、放射学和手术评估。
三级转诊医院。
9例曾发生股骨颈骨折的患者于1995年至1999年间因髋关节疼痛和活动受限接受治疗。所有这些大多为年轻患者（平均年龄33.3岁）均主诉腹股沟疼痛。体格检查时，在屈曲、内收和内旋时被动将股骨颈抵靠髋臼缘可诱发剧痛，且这些动作均受限。
先进行常规X线片检查，如有可能，再行关节造影磁共振成像扫描，然后进行股骨头手术半脱位或脱位，以分析股骨髋臼前撞击症的后遗症。治疗方法为改善前偏移（股骨头前缘与股骨颈之间的差值）或转子间截骨术以改善关节间隙。
术中发现8例患者（1例未手术）的撞击症是由骨折复位不充分所致，这在常规X线片上已可见。股骨头的后扭转（平均20度）在所有患者中均导致前撞击，股骨头额外的内翻位（平均头颈干角115度）在2例患者中导致前外侧撞击。在所有患者中，股骨头手术半脱位或脱位时均发现了前盂唇及相邻髋臼软骨损伤，与磁共振成像扫描所见相似。这些损伤被证明是由头颈交界处与髋臼之间的反复碰撞和挤压所致。
股骨髋臼撞击症可能是既往有股骨颈骨折患者髋关节疼痛和活动受限的原因。该病症会导致前盂唇及相邻髋臼软骨发生退行性病变。早期治疗对于预防关节进一步退变和骨关节炎至关重要。预防的前提是对这类骨折在所有平面进行初始精确的解剖复位。
