Legroux Gerot Isabelle, Demondion Xavier, Louville Anne Bera, Delcambre Bernard, Cortet Bernard
Rheumatology Department, Lille Teaching Hospital, 59037 Lille, France.
Joint Bone Spine. 2004 Mar;71(2):131-5. doi: 10.1016/S1297-319X(03)00050-2.
To describe the main characteristics of subchondral fractures of the femoral head.
CASE-REPORTS: The seven patients, five women and two men, with a mean age of 50 years (37-76 years), presented with mechanical pain in the groin. Bone loss was the main risk factor. Two patients had postmenopausal osteoporosis (including one with a history of ovariectomy at 30 years of age), two had osteoporosis induced by glucocorticoid therapy given after transplantation (liver and allogeneic bone marrow, respectively), one had an ACTH-producing adenoma, and one had femoral osteopenia at a site of topical glucocorticoid therapy for atopic dermatitis. The remaining patient had osteopenia and a history of smoking. Phosphate and calcium levels were normal in five patients. One patient had isolated hypocalciuria and another had moderate proximal tubular disease with phosphate wasting and hypercalciuria. Magnetic resonance imaging (MRI) disclosed a subcapital line of low signal on T1- and T2-weighted sequences surrounded by an area of variable size generating low signal on T1 images and high signal on T2 images, with postgadolinium enhancement, denoting marrow edema. Complete elimination of weight bearing for 6 weeks, symptomatic agents, and treatment of the underlying causes of bone insufficiency were used in all seven patients. Mean follow-up was 2.4 years (range, 11-39 years). No cases of osteonecrosis were recorded.
Several cases of subchondral fracture have been reported in the literature. Bone insufficiency was the main risk factor in all the patients.
描述股骨头软骨下骨折的主要特征。
7例患者，5例女性，2例男性，平均年龄50岁（37 - 76岁），均表现为腹股沟区机械性疼痛。骨质流失是主要危险因素。2例患者患有绝经后骨质疏松症（其中1例有30岁卵巢切除术史），2例因移植后给予糖皮质激素治疗（分别为肝移植和异基因骨髓移植）导致骨质疏松，1例患有促肾上腺皮质激素分泌腺瘤，1例在特应性皮炎局部糖皮质激素治疗部位出现股骨骨质减少。其余患者有骨质减少和吸烟史。5例患者的磷酸盐和钙水平正常。1例患者有孤立性低钙尿症，另1例有中度近端肾小管疾病伴磷酸盐流失和高钙尿症。磁共振成像（MRI）显示在T1加权和T2加权序列上股骨头下低信号线，其周围有大小不一的区域，在T1图像上呈低信号，在T2图像上呈高信号，钆增强后提示骨髓水肿。所有7例患者均采用6周完全负重消除、对症药物治疗以及骨量不足潜在病因的治疗。平均随访2.4年（范围11 - 39年）。未记录到骨坏死病例。
文献中已报道了数例软骨下骨折病例。骨质不足是所有患者的主要危险因素。
