创伤后距骨血管性坏死。

IF 1.2 4区 医学 Q4 DEVELOPMENTAL BIOLOGY
Paul Alexandru Deme, Dan Ioan Fruja, Nicolae Cătălin Hreniuc, Graţian Cosmin Damian, Florin Mihai Marcu, Roland Fazakas, Casiana Boru, Nicoleta Zurbău-Anghel, Alexandru Mircea Pop
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引用次数: 0

摘要

在这份综合病例报告中,我们对一名 29 岁的男性进行了研究,他遭遇了一起高能量车祸,导致距骨 III 型霍金斯骨折。这种特殊的骨折类型与 90% 以上的距骨血管性坏死(AVN)风险密切相关,AVN 是一种严重的致残性疾病。与此同时,患者的内侧和外侧踝骨也发生了骨折。由于大面积肿胀和严重的循环障碍,必须立即进行紧急手术,采用钉子固定作为稳定干预措施。在手术后的 12 个月里,尽管进行了常规的术后影像学检查,包括 X 光和计算机断层扫描(CT),但患者仍然感到明显的疼痛和功能障碍。这种情况导致了进一步的检查,最终在磁共振成像(MRI)中发现距骨穹隆上外侧面有一个面积为 19.8∕20.9 mm 的 AVN。有趣的是,早前的 CT 扫描显示有多处骨质病变,但这些结果缺乏明确的临床对应关系,给诊断带来了挑战。为了解决这一模糊问题并明确区分坏死和感染,有必要进行有针对性的组织病理学分析。这项分析是在拔钉的后续手术过程中提取的一块骨片上进行的。分析结果显示,骨和髓质组织坏死区域明确证实了 AVN 的存在,有效排除了骨炎的潜在诊断。这一重要的诊断结果有助于改变治疗策略,使治疗方案更有针对性,并有可能达到治愈效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Post-traumatic avascular necrosis of the talus.

In this comprehensive case report, we examine a 29-year-old male who suffered a high-energy vehicular accident, resulting in a type III Hawkins fracture of the talus. This specific fracture type is critically associated with a greater than 90% risk of progressing to avascular necrosis (AVN) of the talus, a severe and debilitating condition. Alongside this, the patient sustained fractures of the medial and lateral malleolus. Due to extensive swelling and severe circulatory disorders, an immediate emergency surgical procedure was necessitated, employing nail fixation as a stabilizing intervention. Over the course of 12 months following the surgery, despite routine post-operative imaging including X-rays and computed tomography (CT) scans, the patient continued to experience significant pain and impairment. This condition led to further investigations, culminating in a magnetic resonance imaging (MRI) that revealed an area of 19.8∕20.9 mm of AVN on the talus dome's upper-lateral facet. Interestingly, earlier CT scans had indicated multiple osteitic lesions, but these findings lacked a clear clinical correspondence, presenting a diagnostic challenge. To resolve this ambiguity and to definitively distinguish between necrosis and infection, a targeted histopathological analysis was deemed necessary. This analysis was conducted on a bone fragment extracted during a follow-up surgical procedure for nail removal. The results from this analysis present an area of bone and myeloid tissue necrosis unequivocally confirming the presence of AVN, effectively ruling out osteitis as a potential diagnosis. This critical diagnostic clarification allowed for a shift in therapeutic strategy, enabling the initiation of a more focused and potentially curative treatment regimen.

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来源期刊
CiteScore
1.70
自引率
20.00%
发文量
221
审稿时长
3-8 weeks
期刊介绍: Romanian Journal of Morphology and Embryology (Rom J Morphol Embryol) publishes studies on all aspects of normal morphology and human comparative and experimental pathology. The Journal accepts only researches that utilize modern investigation methods (studies of anatomy, pathology, cytopathology, immunohistochemistry, histochemistry, immunology, morphometry, molecular and cellular biology, electronic microscopy, etc.).
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