Chaus George W, Heare Travis
Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.
Orthopedics. 2012 Jun;35(6):e950-3. doi: 10.3928/01477447-20120525-40.
Osteogenesis imperfecta is an incurable genetic disorder manifested with altered bone quality that predisposes patients to a multitude of fractures throughout their lives, including acetabular fractures. The management of acetabular fractures in patients with osteogenesis imperfecta remains a challenging clinical problem, with a paucity of literature supporting treatments and their outcomes. Limited reports in the literature validate the use of total hip arthroplasty (THA) in patients with osteogenesis imperfecta, and they describe the adult population only.This article describes a case of delayed diagnosis of a transverse acetabular fracture and femoral head impaction fracture that led to posttraumatic end-stage hip osteoarthritis in a 16-year-old boy with osteogenesis imperfecta (Sillence Type I) that was sustained after minimal trauma. Clinical examination 3 months postinjury revealed a significant pelvic obliquity, severe pain with hip range of motion, and limited hip range of motion. Imaging studies revealed a complete loss of articular cartilage and significant joint effusion.The patient underwent THA. No postoperative complications occurred. Two-year follow-up showed an excellent clinical result. The patient's hip was pain free, and he was able to walk with no limp.The authors are unaware of any reported cases of children with osteogenesis imperfecta undergoing THA. Based on the reported literature and the authors' experience, THA can be a reliable surgical option for patients with osteogenesis imperfecta.
成骨不全是一种无法治愈的遗传性疾病，表现为骨质改变，使患者一生中易发生多处骨折，包括髋臼骨折。成骨不全患者髋臼骨折的治疗仍然是一个具有挑战性的临床问题，支持治疗方法及其结果的文献很少。文献中有限的报告证实了全髋关节置换术（THA）在成骨不全患者中的应用，且仅描述了成年人群。本文描述了一例16岁成骨不全（Sillence I型）男孩的病例，该男孩在遭受轻微创伤后发生了髋臼横行骨折和股骨头嵌插骨折，诊断延迟，导致创伤后终末期髋骨关节炎。受伤3个月后的临床检查发现骨盆明显倾斜、髋关节活动时剧痛以及髋关节活动受限。影像学检查显示关节软骨完全丧失且关节积液明显。该患者接受了全髋关节置换术。术后未发生并发症。两年随访显示临床效果极佳。患者髋关节无痛，能够正常行走无跛行。作者未发现有关于成骨不全儿童接受全髋关节置换术的报道病例。基于已报道的文献和作者的经验，全髋关节置换术对于成骨不全患者可以是一种可靠的手术选择。
