Nicholas J J, Haidet E, Helfrich D, Herndon J H, Cooperstein L
Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, PA.
Arch Phys Med Rehabil. 1989 Sep;70(9):696-8.
Three patients with fractures at or near the pubic symphysis presented with groin pain simulating hip fracture or arthritis. A 71-year-old osteoarthritic woman was treated with a nonsteroidal antiinflammatory drug (NSAID) and exercises for right-sided sciatic pain after a minor fall, but developed left groin pain and tenderness over the pubic symphysis after two days of exercise. She had an impacted fracture of the left pubic symphysis which responded to use of a cane. The second patient was a 90-year-old woman with rheumatoid arthritis (on steroids) who complained of right hip pain after a series of falls in her home. Initially treated with Buck traction for a presumed hip fracture, she was later treated with heat and exercises after negative hip x-rays were obtained. Retrospective analysis of pelvic films and bone scan revealed a right pubic symphysis fracture. The third patient was an 83-year-old rheumatoid arthritic woman with inability to walk secondary to left groin pain. Pubic tomograms revealed disruption of the superior aspect, and bone scan showed increased uptake of the left pubic bone. She was treated with moist heat, rest, and NSAID. Twenty-four cases of os pubis fractures without major trauma or symphysis disruption have been reported. All patients had osteoporosis, and six had rheumatoid arthritis. Our three cases are presented to increase awareness of pubic symphysis fractures as a cause for groin pain, especially in patients with osteoporosis and rheumatoid arthritis.
三名耻骨联合处或其附近骨折的患者表现为腹股沟疼痛，类似髋部骨折或关节炎。一名71岁患骨关节炎的女性在轻微跌倒后因右侧坐骨神经痛接受了非甾体抗炎药（NSAID）治疗和锻炼，但在锻炼两天后出现左腹股沟疼痛和耻骨联合处压痛。她有左侧耻骨联合处嵌插骨折，使用拐杖后病情好转。第二名患者是一名90岁患类风湿关节炎（服用类固醇）的女性，在家中多次跌倒后抱怨右髋疼痛。最初因疑似髋部骨折接受了巴克牵引治疗，在髋部X线检查结果为阴性后，她后来接受了热敷和锻炼治疗。对骨盆X线片和骨扫描的回顾性分析显示为右侧耻骨联合处骨折。第三名患者是一名83岁患类风湿关节炎的女性，因左腹股沟疼痛而无法行走。耻骨体层摄影显示上方结构破坏，骨扫描显示左侧耻骨骨摄取增加。她接受了湿热敷、休息和NSAID治疗。已有24例无重大创伤或耻骨联合破坏的耻骨骨折病例报告。所有患者均患有骨质疏松症，其中6例患有类风湿关节炎。现报告我们的3例病例，以提高对耻骨联合处骨折作为腹股沟疼痛原因的认识，尤其是在患有骨质疏松症和类风湿关节炎的患者中。
