Soubrier M, Dubost J J, Rami S, Ristori J M, Bussière J L
Department of Rheumatology, G. Montpied Hospital, Clermont-Ferrand, France.
Rev Rhum Engl Ed. 1995 Jan;62(1):48-52.
Most insufficiency fractures of the femur are transverse fractures of the femoral neck. We report two 77-year-old female patients with longitudinal fractures of the femoral shaft; one had a vertical fracture line in the proximal part of the shaft and the other a spiroid line in the middle third of the shaft. Both patients experienced apparently spontaneous onset of incapacitating mechanical pain in the hip or thigh; duration of the pain at evaluation was ten days in one case and six months in the other. Potential risk factors were osteoarthritis of the hip and the presence of metalwork in the knee. Increased radionuclide activity at the fracture site was seen on the bone scans. In one patient, roentgenographic and computed tomography findings were normal and the diagnosis was established by magnetic resonance imaging. In the other, the fracture line was seen clearly on computed tomography sections. Longitudinal fractures often escape diagnosis initially because roentgenographic changes are delayed. Hyperactivity on the bone scan is suggestive but sometimes so extensive as to mislead the diagnosis. The callus and, less frequently, the fracture line are sometimes seen on computed tomography sections. The role of magnetic resonance imaging remains to be determined.
大多数股骨不全骨折为股骨颈横行骨折。我们报告了两名77岁女性患者，她们均发生股骨干纵行骨折；其中一名患者在股骨干近端有一条垂直骨折线，另一名患者在股骨干中1/3处有一条螺旋形骨折线。两名患者均在髋部或大腿部出现明显自发的致残性机械性疼痛；评估时，一名患者疼痛持续时间为10天，另一名患者为6个月。潜在危险因素为髋骨关节炎和膝关节内有金属植入物。骨扫描显示骨折部位放射性核素活性增加。一名患者的X线和计算机断层扫描结果正常，通过磁共振成像确诊。另一名患者在计算机断层扫描层面上可清晰看到骨折线。纵行骨折最初常难以诊断，因为X线改变出现较晚。骨扫描上的活性增强有提示作用，但有时范围过大，会误导诊断。计算机断层扫描层面上有时可见骨痂，骨折线则较少见。磁共振成像的作用尚待确定。
