Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
Department of Orthopedics, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
BMC Musculoskelet Disord. 2021 Aug 9;22(1):664. doi: 10.1186/s12891-021-04557-2.
During a seizure, there is a powerful and forceful contraction of muscles which may lead to fractures or joint dislocations. However, multiple periprosthetic hip fractures and joint dislocations secondary to seizures have not been reported.
A 49-year-old male developed spontaneous and bilateral multiple periprosthetic hip fractures and joint dislocations (including displaced fracture of the proximal right femur, avulsion fracture of the left lesser trochanter, left acetabular fracture and bilateral joint dislocations) secondary to generalized convulsive seizures which occurred within few hours after bilateral total hip arthroplasties (THAs). Bilateral open reconstruction and fixation were performed on the 21st day after primary THAs and on 2-year follow-up, the patient showed satisfactory functional outcome.
Multiple periprosthetic hip fractures and joint dislocations secondary to seizure are extremely rare, and treatment targets for these injuries should focus on fracture healing and limb function recovery. Craniocerebral operation could bring an elevated risk of seizure; meanwhile, subsequent corticosteroid replacement threapy was complicated by secondary osteoporosis. Therefore, anti-osteoporotic and anti-epileptic therapy should be considered in this type of patients to avoid fracture and dislocation after arthroplasty.
在癫痫发作期间,肌肉会发生强烈有力的收缩,这可能导致骨折或关节脱位。然而,由于癫痫发作导致的假体周围髋关节骨折和关节脱位并不常见。
一名 49 岁男性在双侧全髋关节置换术后数小时内发生全身强直阵挛性癫痫,导致双侧假体周围多处髋关节骨折和关节脱位(包括右侧股骨近端移位性骨折、左侧小转子撕脱性骨折、左侧髋臼骨折和双侧关节脱位)。初次 THA 后第 21 天和 2 年随访时进行了双侧开放性重建和固定,患者的功能恢复结果满意。
由癫痫引起的假体周围多处髋关节骨折和关节脱位极为罕见,治疗目标应侧重于骨折愈合和肢体功能恢复。颅脑手术会增加癫痫发作的风险;同时,后续的皮质类固醇替代治疗会导致继发性骨质疏松症。因此,对于此类患者应考虑抗骨质疏松和抗癫痫治疗,以避免关节置换术后发生骨折和脱位。