类风湿关节炎继发髋臼骨盆内陷合并股骨颈骨折一例报告并文献复习  

Femoral neck fracture in acetabular protrusions secondary to rheumatoid arthritis:a case report and literature review

作　　者：朱宏波 邢丹[1] 侯云飞[1] 李儒军[1] 寇伯龙[1] 林剑浩[1] Zhu Hongbo;Xing Dan;Hou Yunfei;Li Rujun;Kou Bolong;Lin Jianhao(Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing 100044, China;Department of Orthopaedics, Ji Shan Tong Xin Orthopaedic Hospital, Yuncheng 044000, China)

机构地区：[1]北京大学人民医院骨关节科、北京大学关节病研究所,100073 [2]稷山同信骨科医院骨科,运城044000

出　　处：《中华骨科杂志》2019年第3期189-192,共4页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81501919).

摘　　要：报道1例类风湿关节炎继发髋臼骨盆内陷合并股骨颈骨折病例。患者既往有类风湿关节炎病史38年,屈髋拾物时出现左髋疼痛和异响就诊。通过病史、体格检查和影像学检查确诊为类风湿关节炎继发髋臼骨盆内陷合并左侧股骨颈骨折。采用人工全髋关节置换术,术中髋关节脱位、取出股骨头、髋臼重建、臼杯固定和骨量评估是技术性难题。通过文献复习,本例属于继发性髋臼骨盆内陷,可能与类风湿关节炎引起的髋臼软化有关。来自股骨头的压应力超出软化髋臼的承受力时,髋臼突入盆腔,且逐渐包绕股骨头。以此病理改变为基础,推测导致该例患者出现股骨颈骨折的暴力原因为屈髋拾物动作引起的股骨颈-髋臼缘的直接撞击。术中使用螺旋臼假体,既实现了假体的初始稳定性,又保留了髋臼周围的骨量。The present study shows the case of a patient with acetabular protrusions secondary to rheumatoid arthritis progressing to femoral neck fracture. The patient, a 64 years female, had a history of rheumatoid arthritis for 38 years. The left hip pain and abnormal sound occurred when hip flexion for picking up. She was diagnosed with rheumatoid arthritis secondary to acetabular pelvic retraction and left femoral neck fracture by medical history, physical examination and imaging. Total hip arthroplasty was performed after preoperative examination. Hip dislocation, femoral head removal, acetabular reconstruction, cup fixation, and bone mass assessment are technical challenges during surgery. Based on literature review, this case is belonging to secondary acetabular pelvic retraction, which may be related to acetabular softening caused by rheumatoid arthritis. When the stress from the femoral head exceeds the endurance of the softened acetabulum, the acetabulum protrudes into the pelvis and gradually wraps around the femoral head. Based on the pathological characteristics, it is speculated that the cause of femoral neck fracture is the direct hit of the femoral neck-acetabular rim during hip flexion. In this case, spiral cup prosthesis was used to achieve both the initial stability of the prosthesis and saving bone mass around the acetabulum. The patient was followed up for 3 months with satisfactory position of prosthesis and joint function.

关 键 词：类风湿关节炎 侧股骨颈骨折 髋臼重建 文献复习 继发性 内陷 骨盆 人工全髋关节置换术 

分 类 号：R593.22[医药卫生—内科学]