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成骨不全症患者的骨盆环和转子间骨折的手术治疗:5 年随访的病例报告。

Pelvic Ring and Peritrochanteric Fractures in a Patient with Osteogenesis Imperfecta Treated Surgically: Case Report with a 5-Year Follow-Up.

机构信息

Orthopedic Departament , Centre of Postgraduate Medical Education, Otwock, Poland.

Orthopedic Department, Kociewskie Health Centre, Starogard Gdański, Poland.

出版信息

Am J Case Rep. 2022 Nov 23;23:e938414. doi: 10.12659/AJCR.938414.

DOI:10.12659/AJCR.938414
PMID:36417322
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9703951/
Abstract

BACKGROUND Osteogensis imperfecta (OI) is a rare disorder associated with brittle bones, skeletal deformities, short stature, and conductive hearing loss. It is caused by mutations in genes encoding collagen type I production and is associated with multiple fractures occurring during a patient's lifetime. Atypical fractures can occur without a history of previous injury or diagnosis. CASE REPORT A 52-year old man sustained a fall from his own height. He experienced pelvic pain but could bear weight. He was referred to the hospital by his primary care physician and was admitted to the Orthopedic Department with a pelvic ring fracture. We performed open reduction and internal fixation with a reconstruction plate via an intrapelvic approach. At 12 weeks after discharge, he sustained a peritrochanteric fracture. It was surgically treated with a dynamic hip screw. The patient commenced weight-bearing 20 weeks after the initial procedure. Bone union was achieved clinically and radiographically. He did not have any revision procedures. At the time of this report, 5 years after the described period, he felt no discomfort around the hips, sacroiliac joints, and pubic symphysis. CONCLUSIONS OI poses a difficult treatment challenge, but, achieving a good clinical and functional result is possible with a precise surgical technique and meticulous preoperative planning. Clinicians should always consider the possibility of a simultaneous fracture occurrence in different parts of the body. Some patients present without a previous diagnosis, and we should always have some suspicion of OI in cases of young patients presenting with low-energy fractures.

摘要

背景

成骨不全症(OI)是一种罕见的骨骼疾病,其特征为骨骼脆弱、骨骼畸形、身材矮小和传导性听力损失。它是由编码Ⅰ型胶原产生的基因突变引起的,与患者一生中发生的多次骨折有关。非典型骨折可在无既往损伤或诊断史的情况下发生。

病例报告

一名 52 岁男性从其自身高度坠落受伤。他感到骨盆疼痛,但可负重。他由初级保健医生转至医院,并因骨盆环骨折而被收入骨科病房。我们采用经盆腔入路的重建钢板行切开复位内固定治疗。出院后 12 周,他发生股骨转子间骨折。我们采用动力髋螺钉进行了手术治疗。初次手术后 20 周,他开始负重。临床和影像学均证实骨折愈合。他未进行任何翻修手术。截至本报告描述时间,即初次就诊后 5 年,他髋关节、骶髂关节和耻骨联合周围无不适。

结论

OI 治疗具有挑战性,但通过精确的手术技术和细致的术前规划,可以实现良好的临床和功能结果。临床医生应始终考虑身体不同部位同时发生骨折的可能性。有些患者没有既往诊断,对于年轻患者出现低能量骨折,我们应始终怀疑 OI 的可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e722/9703951/03c9fbd5ddd3/amjcaserep-23-e938414-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e722/9703951/cd028c9aa968/amjcaserep-23-e938414-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e722/9703951/19d53b9bcaf5/amjcaserep-23-e938414-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e722/9703951/03c9fbd5ddd3/amjcaserep-23-e938414-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e722/9703951/cd028c9aa968/amjcaserep-23-e938414-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e722/9703951/19d53b9bcaf5/amjcaserep-23-e938414-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e722/9703951/03c9fbd5ddd3/amjcaserep-23-e938414-g003.jpg

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本文引用的文献

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Case Rep Orthop. 2020 Jul 13;2020:8887644. doi: 10.1155/2020/8887644. eCollection 2020.
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Osteogenesis imperfecta: an update on clinical features and therapies.成骨不全症:临床特征和治疗方法的最新进展。
Eur J Endocrinol. 2020 Oct;183(4):R95-R106. doi: 10.1530/EJE-20-0299.
3
Augmentation of simultaneous acetabular and femoral neck fracture in osteogenesis imperfecta using photodynamic bone stabilization - A case report.
应用光动力骨稳定技术治疗成骨不全症合并髋臼及股骨颈同时骨折——1例报告
Trauma Case Rep. 2019 May 14;24:100200. doi: 10.1016/j.tcr.2019.100200. eCollection 2019 Dec.
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Bilateral fractures of acetabulum in a young girl with osteogenesis imperfecta and epilepsy.一名患有成骨不全症和癫痫的年轻女孩双侧髋臼骨折。
Trauma Case Rep. 2019 Nov 27;25:100265. doi: 10.1016/j.tcr.2019.100265. eCollection 2020 Feb.
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Fracture and Dislocation Classification Compendium-2018.《骨折与脱位分类汇编 - 2018》
J Orthop Trauma. 2018 Jan;32 Suppl 1:S1-S170. doi: 10.1097/BOT.0000000000001063.
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