Mirzatolooei Fradin
Department of Orthopaedics, Urmia University of Medical Sciences, Iran.
Acta Orthop Traumatol Turc. 2009;43(6):532-4. doi: 10.3944/AOTT.2009.532.
Traumatic hip dislocation is a relatively rare entity in children. Posterior cruciate ligament (PCL) avulsion is also very rare in children and only a few cases have been reported. Because of the mechanism of injury, coexistent PCL avulsion with posterior dislocation of the hip is frequently seen in adults. This coexistence, however, has not hitherto been reported in children. We present an eight-year-old boy with traumatic posterior dislocation of hip and PCL avulsion. He was brought to hospital after a car accident in which his knee hit to the front part of the car when he was driving a bicycle. He had limitation of motion in the left hip with adduction and flexion deformity and a mild swelling and ecchymosis on the popliteal fossa of the left knee. Pelvic X-ray showed posterior dislocation of the left hip. Closed reduction was performed under general anesthesia. Six weeks later, he presented again with a complaint of limitation of motion in the left knee. On a knee radiograph, an avulsed bony fragment was noted near the medial femoral condyle. Three-dimensional computed tomography with reconstruction showed avulsion of a 0.5-cm fragment from the medial femoral condyle. Because of delay, no surgical intervention was attempted and he received physical therapy for quadriceps strengthening and improvement in the range of motion of the knee. One month after physical therapy, he had 120 degrees of knee flexion with no flexion contracture. Twelve months after injury, the patient had a normal hip and near-full knee flexion. He had no rotary instability and was active in sport.
创伤性髋关节脱位在儿童中是一种相对罕见的病症。后交叉韧带(PCL)撕脱在儿童中也非常罕见,仅有少数病例报道。由于损伤机制,成人中常可见髋关节后脱位合并PCL撕脱。然而,这种并存情况在儿童中迄今尚未见报道。我们报告一名8岁男孩,患有创伤性髋关节后脱位和PCL撕脱。他在一次车祸后被送往医院,当时他骑自行车时膝盖撞到了汽车前部。他左髋关节活动受限,伴有内收和屈曲畸形,左膝腘窝有轻度肿胀和瘀斑。骨盆X线显示左髋关节后脱位。在全身麻醉下进行了闭合复位。六周后,他再次因左膝活动受限前来就诊。膝关节X线片显示股骨内侧髁附近有一个撕脱的骨块。三维计算机断层扫描重建显示股骨内侧髁有一个0.5厘米的骨块撕脱。由于延误,未尝试手术干预,他接受了物理治疗以增强股四头肌力量并改善膝关节活动范围。物理治疗一个月后,他膝关节屈曲达120度,无屈曲挛缩。受伤12个月后,患者髋关节正常,膝关节近乎完全屈曲。他没有旋转不稳定,并且积极参加体育活动。