Hung K H, Lee C T, Gau Y L, Chen J B
Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC.
Ren Fail. 2001 Nov;23(6):827-31. doi: 10.1081/jdi-100108194.
Bilateral femoral neck fractures are rarely reported in patients with end-stage renal disease before chronic dialysis. We report on a 39-year-old woman with neglected bilateral femoral neck fractures, who presented with severe uremic complications prior to chronic dialysis. Three years before admission, she had injured herself in a trivial slip with subsequent bilateral hip pain. She had progressively waddled since then. Pelvic X-ray taken after admission revealed bilateral femoral neck fractures. Bilateral hip hemiarthroplasties were subsequently performed. Displaced femoral neck fractures were found intraoperatively. Pathologic findings and results of examinations supported the coexistence of osteoporosis and high turnover renal osteodystrophy, rendering this woman at high risk of bilateral femoral neck fractures. Therefore, preventing a simple fall or trivial accident and treating renal osteodystrophy and osteoporosis are paramount in patients with chronic renal failure even before the start of dialysis therapy. We also emphasize the need to seek any possible underlying metabolic bone disease once a patient presents with unusual fractures.
双侧股骨颈骨折在慢性透析前的终末期肾病患者中鲜有报道。我们报告了一名39岁患有双侧股骨颈骨折但未得到治疗的女性，她在慢性透析前出现了严重的尿毒症并发症。入院前三年，她在一次轻微滑倒中受伤，随后双侧臀部疼痛。从那时起，她逐渐开始蹒跚行走。入院后进行的骨盆X光检查显示双侧股骨颈骨折。随后进行了双侧髋关节半关节置换术。术中发现股骨颈骨折移位。病理检查结果支持骨质疏松症和高转换型肾性骨营养不良并存，这使得该女性发生双侧股骨颈骨折的风险很高。因此，即使在透析治疗开始之前，对于慢性肾衰竭患者来说，预防简单的跌倒或轻微事故以及治疗肾性骨营养不良和骨质疏松症至关重要。我们还强调，一旦患者出现异常骨折，就需要寻找任何可能存在的潜在代谢性骨病。
