Acta Orthop Belg. 2021 Mar;87(1):25-34.
Spontaneous subcapital fracture (SSF) of femoral neck in pre-existent osteonecrosis of femoral head (ONFH) is a rare presentation. Only a few cases have been reported so far and majority of them have been reported to have unilateral hip involvement. We retrospectively reviewed clinical-radiological data of 10 patients (12 hips) with SSF complicating ONFH. All of them underwent uncemented total hip arthroplasty. All the available publications in the English language based medical literature were critically reviewed and results were summarized. The median age of presentation was 32 years (range : 24 years to 61 years). They were followed up for a mean duration of 25 months (range : 12 months to 59 months). The most common risk factor was corticosteroid consumption (7 out of 10 patients). All except one (modified Ficat and Arlet stage II) belonged to advanced stage of ONFH {stage III 3 patients (3 hips), stage IV 6 patients (8 hips)}. The mean time lag of ONFH to presentation was 22.3 months (range : 5 months to 60 months), and SSF to presentation was 13.8 days (range : 1 day to 28 days). Mean pre- operative Harris Hip Score was 10.8 (range : 8 to 14), which improved to 93 (range : 91 to 96) after total hip arthroplasty when last followed up (p<0.05). Corticosteroids induced ONFH has a propensity to develop SSF. This entity should find a place in existing classification system.
预先存在的股骨头坏死 (ONFH) 中的自发性股骨颈骨干骨折 (SSF) 较为罕见。到目前为止，只有少数病例被报道，而且大多数病例都涉及单侧髋关节受累。我们回顾性分析了 10 例（12 髋）伴有 ONFH 并发 SSF 的患者的临床-影像学资料。所有患者均接受非骨水泥全髋关节置换术。我们对基于英文医学文献的所有可用出版物进行了批判性审查，并对结果进行了总结。发病时的中位年龄为 32 岁（范围：24 岁至 61 岁）。他们的平均随访时间为 25 个月（范围：12 个月至 59 个月）。最常见的危险因素是皮质类固醇的使用（10 例中有 7 例）。除 1 例（改良 Ficat 和 Arlet 分期 II）外，其余均属于 ONFH 的晚期（3 例髋为 III 期，6 例髋为 IV 期）。ONFH 至发病的平均时间间隔为 22.3 个月（范围：5 个月至 60 个月），SSF 至发病的平均时间间隔为 13.8 天（范围：1 天至 28 天）。术前 Harris 髋关节评分平均为 10.8（范围：8 至 14），末次随访时全髋关节置换术后平均评分为 93（范围：91 至 96）（p<0.05）。皮质类固醇诱导的 ONFH 有发生 SSF 的倾向。这种情况应在现有的分类系统中占有一席之地。
