Orthopaedic Department, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway.
Injury. 2012 Oct;43(10):1672-7. doi: 10.1016/j.injury.2012.05.025. Epub 2012 Jul 5.
The purpose of this study was to assess the natural history of bone bruise and bone mineral density (BMD) after traumatic hip dislocations and conservatively treated acetabular fractures. Our hypothesis was that poor bone quality can influence degree of bone bruise and, in time, cause degenerative changes.
Eight consecutive patients with traumatic hip dislocations and five patients with conservatively treated fractures in the femoral head and/or acetabulum were included. Magnetic resonance imaging (MRI) was obtained after 1, 17, 42, 82 and 97 weeks. Dual-emission X-ray absorptiometry (DXA) measurements were made after 10 days and 2 years. Sizes of bone bruise lesions were measured and classified. At the 2-year follow-up, Harris hip score (HHS) was calculated and signs of radiological osteoarthritis (OA) registered.
The bone bruise changes were small and all changes resolved within 42 weeks in all, except for three patients; one with a small Pipkin fracture had segmental avascular necrosis (AVN) of the femoral head, one had persisting1-3mm small spots of bone bruises in the femoral head and the third had <1cm lesions in both the femoral head and the acetabulum. The lesions were bigger in the femoral head in the hip dislocations and more pronounced in the acetabulum in the fractured acetabuli. We found no significant changes in BMD in four regions of interest (ROIs) after 2 years. No patients developed OA, and all had excellent HHS except for the one patient with AVN.
The post-traumatic bone bruise changes in the dislocated hips and the fractured acetabuli were small and transient compared to findings of other authors examining traumatised knees. The patients had excellent function and no OA after 2 years if they did not develop AVN. In our small sample of relatively young patients with normal age-adjusted BMD, no post-traumatic osteopenia was observed. This might differ in the elderly with poorer bone quality; further studies are needed to assess that.
本研究旨在评估创伤性髋关节脱位和保守治疗髋臼骨折后骨挫伤和骨密度（BMD）的自然病程。我们的假设是，骨质量差会影响骨挫伤的程度，并随着时间的推移导致退行性变化。
连续纳入 8 例创伤性髋关节脱位患者和 5 例保守治疗股骨头和/或髋臼骨折患者。在 1、17、42、82 和 97 周时进行磁共振成像（MRI）检查。在 10 天和 2 年后进行双能 X 线吸收法（DXA）测量。测量骨挫伤病变的大小并进行分类。在 2 年随访时，计算 Harris 髋关节评分（HHS）并登记放射学骨关节炎（OA）的迹象。
骨挫伤的变化很小，除了 3 例患者外，所有患者在 42 周内均得到缓解，其中 1 例发生小的 Pipkin 骨折伴股骨头节段性缺血性坏死（AVN），1 例股骨头内持续存在 1-3mm 的小骨挫伤斑，另 1 例股骨头和髋臼内均有<1cm 的病变。髋关节脱位的股骨头骨挫伤病变较大，髋臼骨折的髋臼骨挫伤病变更为明显。在 2 年后的 4 个感兴趣区域（ROI）中，我们没有发现 BMD 有显著变化。没有患者发生 OA，除了发生 AVN 的患者外，所有患者的 HHS 均为优秀。
与其他研究创伤性膝关节的作者相比，髋关节脱位和髋臼骨折后发生的创伤后骨挫伤变化较小且短暂。如果患者没有发生 AVN，则在 2 年后具有良好的功能且没有 OA。在我们相对年轻且 BMD 正常的患者中，未观察到创伤后骨质疏松症。在骨质量较差的老年人中可能会有所不同，需要进一步研究来评估。
