明显孤立性大转子骨折的髋关节脂血关节病。

IF 1.9 2区 医学 Q2 ORTHOPEDICS
Clinics in Orthopedic Surgery Pub Date : 2025-04-01 Epub Date: 2025-02-25 DOI:10.4055/cios24358
Hee Joong Kim, Kyungpyo Nam, Jeong Joon Yoo, Hong Seok Kim
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引用次数: 0

摘要

背景:髋关节脂血症是检测隐匿性股骨颈或髋臼骨折的关键指标,但在孤立性大转子(IGT)骨折中尚未见报道。本研究回顾性分析了疑似IGT骨折的三维计算机断层扫描(3D-CT)图像,以了解脂血关节的发生频率及其对内固定必要性的影响。方法:对2004年10月至2019年12月90例疑似IGT骨折患者进行3D-CT评估。排除随访不充分6例及金属植入物所致影像学质量差8例后,最终纳入76例。该队列包括48名女性和28名男性,平均年龄为77岁(范围39-97岁)。仔细检查3D-CT图像以确定受影响髋关节的脂血关节病。另外,13例患者行磁共振(MR)检查。结果:63例IGT骨折;粗隆间区CT未见皮质破坏。其中56例保守治疗成功。5例(7.9%)发现脂血关节病,其中2例经保守治疗成功。其余13例为不完全性股骨粗隆间骨折,CT表现为股骨粗隆间区前皮质断裂。其中3例(21.3%)出现脂血关节病。在所有磁共振成像评估的病例中(10例IGT骨折和3例不完全性转子间骨折),均观察到不同程度的髓内转子间延伸。其中,仅有2例IGT骨折检测到脂血关节,其中在中冠状位图像上髓内延伸未越过中线。一例手术修复,另一例保守治疗成功。值得注意的是,4例股骨粗隆间伸过中线的患者未出现脂血关节病。结论:不完全粗隆间骨折比IGT骨折更容易发生脂血关节。然而,仅存在脂血关节病不应被视为内固定的指征。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Lipohemarthrosis of the Hip Joint in Apparently Isolated Greater Trochanter Fractures.

Backgroud: Lipohemarthrosis in the hip joint, a critical indicator for detecting occult femoral neck or acetabular fractures, has not been reported in cases of isolated greater trochanter (IGT) fractures. This study retrospectively reviewed 3-dimensional computed tomography (3D-CT) images of what appeared to be IGT fractures to find out the frequency of lipohemarthrosis and its implication for the necessity of internal fixation.

Methods: From October 2004 to December 2019, 90 cases of suspected IGT fractures were evaluated using 3D-CT. After excluding 6 cases due to inadequate follow-up and 8 cases with poor imaging quality caused by metallic implants, 76 cases were included in the final analysis. The cohort consisted of 48 women and 28 men, with a mean age of 77 years (range, 39-97 years). The 3D-CT images were meticulously reviewed to identify lipohemarthrosis in the affected hip joints. Additionally, magnetic resonance (MR) images were available for 13 cases.

Results: Sixty-three cases were IGT fractures; no cortical disruption was detected in the intertrochanteric area on CT images. Of these, 56 cases were successfully treated conservatively. Lipohemarthrosis was detected in 5 cases (7.9%), of which 2 were successfully managed with conservative treatment. The remaining 13 cases were classified as incomplete intertrochanteric fractures, with anterior cortical disruption identified in the intertrochanteric area on CT images. Lipohemarthrosis was observed in 3 of these cases (21.3%). In all cases evaluated with MR imaging (10 IGT fractures and 3 incomplete intertrochanteric fractures), varying degrees of intramedullary intertrochanteric extension were observed. Among these, lipohemarthrosis was detected in only 2 cases of IGT fracture, where the intramedullary extension did not cross the midline on mid-coronal images. One case was surgically fixed, but the other case was treated conservatively with success. Notably, 4 cases with intertrochanteric extension crossing the midline did not exhibit lipohemarthrosis.

Conclusions: Lipohemarthrosis was more frequently observed in incomplete intertrochanteric fractures than in IGT fractures. However, the presence of lipohemarthrosis alone should not be regarded as an indication for internal fixation.

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来源期刊
CiteScore
3.50
自引率
4.00%
发文量
85
审稿时长
36 weeks
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