Ren Hanru, Huang Qikai, He Jiawen, Wang Yongan, Wu Lianghao, Yu Baoqing, Zhang Dianying
Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, No. 2800, Gongwei Road, Shanghai, 200120, China.
Department of Orthopaedics, Peking University People's Hospital, Peking, 100044, China.
BMC Musculoskelet Disord. 2019 Feb 14;20(1):79. doi: 10.1186/s12891-019-2457-8.
A fracture in the isolated greater trochanter is an infrequent type of femoral intertrochanteric fracture. The gluteus medius and gluteus minimus are abducent muscle groups with attachments located on the greater trochanter. Thus, a fracture of the greater trochanter could cause avulsion injury of these attachment points and eventually affect the abducent function of the hip joint and cause chronic pain. Despite these prospects, the impact of a greater trochanter fracture on abducent strength and hip joint function have yet to be investigated.
Patients who were diagnosed with an isolated greater trochanter fracture (via computed tomography scan and X-ray) and underwent conservative treatment from June 2013 to October 2016 were included in the present study. Magnetic resonance imaging (MRI) was used to verify the morbidity of recessive fractures. Patients' Harris Hip Scores were determined at 3 months, 6 months, and 12 months and the abducent strength and range of motion of the hip joint on the injured side were analyzed and compared to those on the healthy side.
Among 32 patients, there were 7 individuals diagnosed with isolated greater trochanter fractures by MRI, and 25 individuals whose fractures were found to have extended into the intertrochanteric region, wherein the recessive intertrochanteric region fractures had no relationship with patients' age, gender, or weight. After 12 months of conservative treatment, 7 patients still complained of pain in the hip joint. The average Harris Hip Score was 87.84 ± 4.83, and the abducent range of the hip joint on the injured side (42.02 ± 13.93°) was not significantly different from that of the healthy side (46.24 ± 7.93°). The abducent strength of the hip joint of the injured side was 121.32 ± 41.06 N which was significantly lower than that of healthy side (137.44 ± 42.21 N).
Results from this investigation suggest that an isolated greater trochanter fracture attenuates the abducent strength of the hip joint, which may be related to injuries of the ligaments and muscles around the greater trochanter. The surgical skills and methods of addressing isolated greater trochanter fractures merit further investigation.
孤立性大转子骨折是股骨转子间骨折中较为少见的一种类型。臀中肌和臀小肌是附着于大转子的外展肌群。因此，大转子骨折可能导致这些附着点的撕脱伤，最终影响髋关节的外展功能并引起慢性疼痛。尽管存在这些情况，但大转子骨折对外展力量和髋关节功能的影响尚未得到研究。
本研究纳入了2013年6月至2016年10月期间经计算机断层扫描和X线诊断为孤立性大转子骨折并接受保守治疗的患者。采用磁共振成像（MRI）来证实隐性骨折的发病率。在3个月、6个月和12个月时测定患者的Harris髋关节评分，并分析和比较患侧髋关节的外展力量和活动范围与健侧的情况。
32例患者中，MRI诊断为孤立性大转子骨折的有7例，骨折延伸至转子间区域的有25例，其中隐性转子间区域骨折与患者的年龄、性别或体重无关。经过12个月的保守治疗后，7例患者仍主诉髋关节疼痛。Harris髋关节评分平均为87.84±4.83，患侧髋关节的外展范围（42.02±13.93°）与健侧（46.24±7.93°）无显著差异。患侧髋关节的外展力量为121.32±41.06N，明显低于健侧（137.44±42.21N）。
本研究结果表明，孤立性大转子骨折会减弱髋关节的外展力量，这可能与大转子周围韧带和肌肉的损伤有关。处理孤立性大转子骨折的手术技巧和方法值得进一步研究。
