Department of Orthopaedic Surgery, Asan Medical Center, Seoul, Korea.
Department of Orthopaedic Surgery, Yeson Hospital, Bucheon, Korea.
Clin Orthop Surg. 2023 Apr;15(2):203-210. doi: 10.4055/cios22044. Epub 2022 Aug 19.
Subchondral fatigue fracture of the femoral head (SFFFH) is a rare disease, and its disease entity is established in recent decades. Although there are a few studies on SFFFH, most of them are case series involving around 10 cases, and the clinical course of SFFFH is still not well known. This study analyzed the factors affecting the clinical course of SFFFH.
Patients who visited our institution from October 2000 to January 2019 were retrospectively evaluated. Of eligible cases, 89 hips (80 patients) were diagnosed with SFFFH and non-surgical treatment outcomes were analyzed. Radiographs and medical charts were reviewed for following factors: the degree of femoral head collapse, the interval between the onset of hip pain and the first hospital visit, hip dysplasia, osteoarthritic changes, sex, and age.
Hip pain decreased in 82 cases (92.1%) through non-surgical treatment, and 7 cases (7.9%) underwent surgery. Patients with good results of non-surgical treatment had improvement 2.9 months on average after the treatment. All cases without a collapsed femoral head (55 cases) had hip pain alleviation through non-surgical treatment. Cases with femoral head collapse of 4 mm or less and non-surgical treatment within 6 months from the onset of hip pain (22 cases) all had hip pain alleviation. Among 8 cases with femoral head collapse of 4 mm or less and non-surgical treatment after 6 months or more from the onset of hip pain, 3 underwent surgery and 1 had persistent hip pain. Those with femoral head collapse of over 4 mm (3 cases) all underwent surgery. The osteoarthritic changes, dysplastic hip, sex, and age were not statistically related to the success of non-surgical treatment.
The success of non-surgical treatment for SFFFH can be affected by the degree of femoral head collapse and the timing of non-surgical treatment.
股骨头下骨疲劳骨折（SFFFH）是一种罕见的疾病，其疾病实体是在近几十年才确立的。虽然有一些关于 SFFFH 的研究，但大多数都是涉及 10 例左右的病例系列研究，SFFFH 的临床病程仍不清楚。本研究分析了影响 SFFFH 临床病程的因素。
回顾性评估了 2000 年 10 月至 2019 年 1 月期间来我院就诊的患者。在符合条件的病例中，89 髋（80 例）被诊断为 SFFFH，并对非手术治疗结果进行了分析。对以下因素进行了影像学和病历回顾：股骨头塌陷程度、髋关节疼痛出现至首次就诊的间隔时间、髋关节发育不良、骨关节炎变化、性别和年龄。
82 例（92.1%）患者经非手术治疗后髋关节疼痛减轻，7 例（7.9%）患者接受了手术。非手术治疗效果良好的患者在治疗后平均 2.9 个月疼痛缓解。所有无股骨头塌陷（55 例）的患者均通过非手术治疗缓解了髋关节疼痛。股骨头塌陷 4mm 或以下且从髋关节疼痛出现到开始非手术治疗的时间在 6 个月以内的病例（22 例）均缓解了髋关节疼痛。在股骨头塌陷 4mm 或以下且从髋关节疼痛出现到开始非手术治疗的时间超过 6 个月的 8 例患者中，有 3 例接受了手术，1 例仍有髋关节疼痛。股骨头塌陷超过 4mm（3 例）的患者均接受了手术。骨关节炎变化、髋关节发育不良、性别和年龄与非手术治疗的成功率无统计学相关性。
股骨头下骨疲劳骨折非手术治疗的成功率受股骨头塌陷程度和非手术治疗时机的影响。
