Sterling J C, Webb R F, Meyers M C, Calvo R D
Texas Center for Sports Medicine and Orthopedic Surgery, Sugar Land.
Med Sci Sports Exerc. 1993 Feb;25(2):179-85.
Stress fractures are more prevalent in today's fitness cognizant society. Stress fractures of the femoral neck are common and present with specific symptoms and findings. The diagnosis is based on clinical history, physical exam, radiography, bone scintigraphy, and computed tomography (C.T.) scans. The triple-phase bone scan is the most sensitive test for the diagnosis of stress fractures and is considered the gold standard for the diagnosis of the occult stress fracture. This case presents a 42-yr-old female marathon runner who presented with hip pain and clinical symptoms indicating a stress fracture of the femoral neck. Initial radiographs and a triple-phase bone scan were negative. When symptoms persisted, a repeat x-ray revealed a femoral neck fracture of the superior surface. In spite of a false negative bone scan, clinical suspicion allowed appropriate treatment of this femoral neck stress fracture. Nondiagnosed stress fractures of the femoral neck may lead to severe disability, including avascular necrosis of the femoral head. Therefore, clinical index of suspicion is very important even if ancillary tests are nondiagnostic.
应力性骨折在当今注重健康的社会中更为普遍。股骨颈应力性骨折很常见，会出现特定的症状和表现。诊断基于临床病史、体格检查、X线摄影、骨闪烁显像和计算机断层扫描（CT）。三相骨扫描是诊断应力性骨折最敏感的检查，被认为是隐匿性应力性骨折诊断的金标准。本病例为一名42岁的女性马拉松运动员，出现髋部疼痛及提示股骨颈应力性骨折的临床症状。最初的X线片和三相骨扫描均为阴性。当症状持续存在时，再次X线检查显示上表面股骨颈骨折。尽管骨扫描出现假阴性，但临床怀疑使得该股骨颈应力性骨折得到了恰当治疗。未被诊断出的股骨颈应力性骨折可能导致严重残疾，包括股骨头缺血性坏死。因此，即使辅助检查无诊断意义，临床怀疑指标也非常重要。
