Tountas A A
Division of Orthopaedic Surgery, Northwestern General Hospital, Toronto, Ontario, Canada.
Clin Orthop Relat Res. 1993 Jul(292):202-9.
Thirteen insufficiency stress fractures of the femoral neck in 13 elderly patients (average age, 82 years) were studied retrospectively. All occurred in Caucasian women with severe osteoporosis. A vague pain about the hip, of spontaneous onset, was the main symptom on first visit. The diagnosis was delayed in most cases because the clinical findings were minimal and the early roentgenographic features were absent or subtle. Bone scintigraphy was found more useful than roentgenography for diagnosing this entity. A completely displaced stress fracture of the femoral neck could not be distinguished clinically or roentgenographically from a traumatic subcapital femoral fracture. Internal fixation was the treatment method associated with the more favorable results. The histologic examination of removed femoral heads indicated that this entity is a dynamic metabolic process. Insufficiency stress fractures of the femoral neck in the elderly are not uncommon, but unless suspected, the condition can be easily overlooked, and if displaced, mistaken for trauma-induced subcapital femoral fractures.
对13例老年患者（平均年龄82岁）的13处股骨颈应力性骨折进行了回顾性研究。所有病例均发生于患有严重骨质疏松症的白人女性。首次就诊时的主要症状是髋部出现自发的隐痛。由于临床表现轻微且早期X线特征不明显或不典型，大多数病例的诊断被延迟。发现骨闪烁显像在诊断该病时比X线检查更有用。股骨颈完全移位的应力性骨折在临床或X线检查上无法与创伤性股骨颈头下骨折相区分。内固定是效果较好的治疗方法。对切除的股骨头进行组织学检查表明，该病是一个动态的代谢过程。老年人股骨颈应力性骨折并不少见，但除非加以怀疑，该病很容易被忽视，而且如果发生移位，则会被误诊为创伤性股骨颈头下骨折。
