Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-3-1 Kuzuharatakamatsu, Kokuraminami-ku, Kitakyushu 800-0296, Japan.
Clin Orthop Relat Res. 2010 May;468(5):1331-5. doi: 10.1007/s11999-009-1213-z. Epub 2010 Jan 8.
Subchondral insufficiency fracture of the femoral head occurs mainly in elderly patients with osteoporosis. Spontaneous resolution is observed after nonoperative treatment in some patients whereas other show progressive joint destruction requiring THA. Several studies report the occurrence of subchondral insufficiency fracture of the femoral head in dysplastic hips.
QUESTIONS/PURPOSES: We asked whether the extent of hip dysplasia or osteoporosis was greater in patients with subchondral insufficiency fracture of the femoral head than in normal control subjects.
We compared the clinical and imaging findings of 13 patients with subchondral insufficiency fractures of the femoral head and 12 patients scheduled for TKA with asymptomatic hips. Age, gender, and body mass index were comparable in the two groups.
Higher mean Sharp angles, lower acetabular head indices, lower center-edge angles, and higher acetabular roof angles in patients with subchondral insufficiency fracture of the femoral head than in those with asymptomatic hips suggested a greater degree of hip dysplasia. Bone mineral density and serum levels of Type I collagen cross-linked N-telopeptide and bone alkaline phosphatase were similar in the two groups.
We speculate an excessive amount of stress on the acetabular edge from dysplasia may be associated with the occurrence of subchondral insufficiency fracture of the femoral head.
股骨头下骨不全骨折主要发生于骨质疏松的老年患者。一些患者经非手术治疗后可自发缓解，而另一些患者则出现进行性关节破坏，需要接受全髋关节置换术（THA）。一些研究报告称，在发育不良的髋关节中也会发生股骨头下骨不全骨折。
问题/目的：我们想知道股骨头下骨不全骨折患者的髋关节发育不良程度或骨质疏松程度是否大于正常对照组。
我们比较了 13 例股骨头下骨不全骨折患者和 12 例无症状髋关节行 TKA 的患者的临床和影像学表现。两组患者的年龄、性别和体重指数相当。
股骨头下骨不全骨折患者的平均 Sharp 角较高，髋臼指数较低，中心边缘角较低，髋臼顶角度较高，这表明髋关节发育不良程度更严重。两组患者的骨密度、I 型胶原交联 N 端肽和骨碱性磷酸酶的血清水平相似。
我们推测，发育不良导致的髋臼边缘过度受力可能与股骨头下骨不全骨折的发生有关。
