Ji Yunxiao, Li Kangpeng, Zhang Yao, Zhao Changsong, Zhang Qiang
Beijing Ditan Hospital, Capital Medical University, Beijing, China.
BMC Musculoskelet Disord. 2024 Oct 1;25(1):772. doi: 10.1186/s12891-024-07827-x.
HIV is widely prevalent in all regions of the world. The use of antiretroviral drugs has dramatically reduced the mortality rate of HIV-related diseases, but correspondingly increased the incidence of chronic complications in HIV-positive people. Related studies have found that the incidence of osteonecrosis of the femoral head is higher in HIV-positive people, but the co-occurrence of femoral head necrosis, acetabular necrosis and hip joint dislocation in HIV-positive patients is rare.
We report a 50-year-old man with a 15-month history of progressively worsening right hip pain with movement restriction. According to the CT findings of the other hospital, the patient was admitted to the hospital with femoral head necrosis. After the admission, the relevant X-ray, CT and MRI examinations showed that the right femoral head collapsed and deformed, with the surrounding bone sclerosis, bone fragments, loose body of the joint, right hip subluxation, acetabular marginal osteogeny, and local microcystic degeneration. The left femoral head was in good shape, and cystic degeneration can be seen under the articular surface. The patient was finally diagnosed with femoral head necrosis and acetabular necrosis combined with hip subluxation.
The pain of the patient was significantly relieved after the operation, and the patient was discharged from the hospital one week after the start of treatment to continue rehabilitation training. During the follow-up one month after the operation, the self-reported pain disappeared completely, and the limitation of activity was significantly improved.
艾滋病毒在世界所有地区广泛流行。抗逆转录病毒药物的使用显著降低了艾滋病毒相关疾病的死亡率，但相应增加了艾滋病毒阳性者慢性并发症的发生率。相关研究发现，艾滋病毒阳性者股骨头坏死的发生率较高，但艾滋病毒阳性患者同时出现股骨头坏死、髋臼坏死和髋关节脱位的情况较为罕见。
我们报告一名50岁男性，有15个月逐渐加重的右髋部疼痛伴活动受限病史。根据外院CT检查结果，该患者因股骨头坏死入院。入院后，相关X线、CT和MRI检查显示右股骨头塌陷变形，周围骨质硬化、骨碎片、关节游离体、右髋关节半脱位、髋臼边缘骨质增生及局部微囊性变。左股骨头形态良好，关节面下可见囊性变。该患者最终被诊断为股骨头坏死合并髋臼坏死伴髋关节半脱位。
术后患者疼痛明显缓解，治疗开始一周后出院继续康复训练。术后1个月随访期间，自述疼痛完全消失，活动受限明显改善。
