高能股骨骨干骨折中囊袋膨胀与隐匿性股骨颈骨折相关：一项初步的回顾性对比研究。

Capsular distension in high-energy femoral shaft fractures is associated with occult femoral neck fracture: a preliminary retrospective comparative study.

机构信息

Department of Orthopaedic Surgery, University of Hawaii, 1356 Lusitana Street, 6th Floor, Honolulu, HI, 96813, USA.

Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA, USA.

出版信息

Eur J Orthop Surg Traumatol. 2024 Jan;34(1):599-604. doi: 10.1007/s00590-023-03696-7. Epub 2023 Sep 3.

DOI:10.1007/s00590-023-03696-7

PMID:37660313

Abstract

OBJECTIVES

To determine the association between hip capsular distension, the computed tomography (CT) capsular sign, and lipohemarthrosis as they relate to occult femoral neck fracture (FNF) in the setting of ipsilateral femoral shaft fracture (FSF).

DESIGN

Retrospective comparative study.

SETTING

Level 1 trauma center.

PATIENTS/PARTICIPANTS: Two hundred and forty-two patients with high-energy FSF and no evidence of FNF on preoperative radiographs and pelvis CT. All patients were stabilized with non-reconstruction style nails.

INTERVENTION

Pelvis CT scans were examined for hip capsular distension irrespective of the other side, differing side-to-side measurements of capsular distension (i.e., the CT capsular sign), and lipohemarthrosis.

MAIN OUTCOME MEASUREMENTS

FNF was observed for on postoperative radiographs. Relative risk (RR), number needed to treat (NNT), sensitivity (SN), and specificity (SP) were determined.

RESULTS

Fifty-eight patients (24.0%) had capsular distension. Forty-two patients (17.4%) had differing capsular measurements (i.e., the CT capsular sign), and 16 (6.6%) had symmetrical distension from bilateral hip effusions. Eight patients (3.3%) had lipohemarthrosis. Four FNFs (1.7%) were identified. Three patients had capsular distension, 2 had CT capsular signs, and 1 had lipohemarthrosis. The last patient had no CT abnormalities. Only capsular distension (RR = 10, CI = 1.001-90, P = 0.049; SN = 75%, SP = 77%; NNT = 22) and lipohemarthrosis (RR = 23, CI = 1.6-335, P = 0.022; SN = 50%, SP = 96%; NNT = 8) were associated with occult FNF.

CONCLUSIONS

Capsular distension is associated with FNF irrespective of the contralateral hip. Preemptive stabilization using a reconstruction nail could be considered in the setting of capsular distension or lipohemarthrosis to prevent displacement of an occult FNF.

LEVEL OF EVIDENCE

Diagnostic Level III.

摘要

目的

确定髋关节囊扩张、计算机断层扫描（CT）囊袋征以及脂肪血肿与同侧股骨干骨折（FSF）伴隐匿性股骨颈骨折（FNF）的关系。

设计

回顾性对比研究。

地点

1 级创伤中心。

患者/参与者：242 名高能量 FSF 患者，术前 X 线和骨盆 CT 均无 FNF 证据。所有患者均采用非重建式髓内钉固定。

干预措施

检查骨盆 CT 扫描，观察髋关节囊扩张情况，不考虑对侧情况，测量囊袋扩张的两侧差异（即 CT 囊袋征）和脂肪血肿。

主要观察指标

术后 X 线观察 FNF。确定相对风险（RR）、需要治疗的人数（NNT）、敏感度（SN）和特异性（SP）。

结果

58 例患者（24.0%）存在囊袋扩张。42 例患者（17.4%）有不同的囊袋测量值（即 CT 囊袋征），16 例（6.6%）双侧髋关节积液导致对称扩张。16 例（6.6%）患者出现脂肪血肿。8 例（3.3%）患者出现脂肪血肿。4 例 FNF（1.7%）被发现。3 例患者有囊袋扩张，2 例有 CT 囊袋征，1 例有脂肪血肿。最后一名患者 CT 无异常。只有囊袋扩张（RR=10，CI=1.001-90，P=0.049；SN=75%，SP=77%；NNT=22）和脂肪血肿（RR=23，CI=1.6-335，P=0.022；SN=50%，SP=96%；NNT=8）与隐匿性 FNF 相关。