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髋臼骨折 - 原因、症状和治疗

概述

我们的 时髦的 joint is a ball and socket joint. The ball refers to the head of the femur (the thighbone) and the socket refers to the acetabular notch, part of the hip bone. The term acetabular fracture is used for fractures in the socket of the hip joint.  

Acetabular fractures are much less common than the fractures of the ball of the femur or other femoral fractures. According to some sources, only 10% of the total pelvic fractures are comprised of acetabular fractures. In this article, we will discuss some causes, treatments, and complications associated with acetabular fractures. 

解剖学

时髦的 关节是我们身体的一个大而重要的关节。它有助于稳定我们的身体并将躯干的重量传递到腿部。如上所述,它是一种球窝式接头。髋臼形成承窝,股骨(头部)形成球。 

The bones making the joint are covered by a smooth and slippery articular cartilage that works to reduce the friction between the ball and socket. The joint’s stability or strength comes from the strong ligaments that attach one bone to the other. A lot of our important organs, vessels, and nerves are in close proximity to the pelvic bones and these viscera can get damaged due to an acetabular fracture.  

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体征和症状

髋臼骨折的症状确实因骨折的严重程度而异。在某些情况下,髋臼只有轻微的裂缝,而在其他严重的情况下,髋臼可能会碎裂成几块。像我们身体的其他所有骨折一样,症状包括: 

  • 疼痛 – this could be severe pain that gets aggravated more with movement. At times even a slight movement is impossible to perform due to the immense pain caused by fractures. 
  • 麻木或刺痛 – if a nearby nerve gets damaged due to fractures, bones compressing or stretching the nerve leads to weakness or numbness in the area that the nerve is supplying.

原因和风险因素

当股骨头对承窝施加巨大的力时,会发生髋臼骨折,最终会破坏承窝。自动碰撞(车祸)是这种力量的主要来源。在事故中,您的膝盖撞到仪表板或方向盘会通过股骨头对您的髋臼施加压力。它也可能是由臀部两侧的直接跌落引起的,迫使股骨头进入承窝,使其断裂。 

从事接触性运动的运动员也可能出现这种骨折,尤其是参加澳大利亚橄榄球、足球和体操的运动员。一些风险因素包括: 

  • 年龄 – elderly people have weakened bones and ligaments that can reduce the pressure resisting capacity of these bones, causing them to fracture more easily.  
  • 营养不良 – lacking a good diet, especially lack of calcium and vitamin D can cause you to have weaker bones.
  • 原发疾病 – disorders that cause weakening of the bones i.e., hyperparathyroidism, osteomyelitis, osteoporosis, etc. can increase the risk of you getting an acetabular fracture. 

诊断

高冲击性骨折的人几乎总是在紧急情况下来医院。在稳定您的疼痛后,您的医生可能会记录您的病史,进行体格检查,并要求一些其他诊断技术来确认您是否患有髋臼骨折。这些诊断技术包括: 

  • X 射线 – X-rays for acetabular fractures are taken from various angles to asses the severity of the fracture. 
  • CT扫描 – it is a commonly ordered scan that provides a more detailed view of the bones in the pelvis and the fractured bones. 
James Heilman,医学博士,CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0,通过维基共享资源

治疗

治疗取决于骨折的严重程度和模式以及您的整体健康状况。髋臼骨折有几种治疗选择: 

  • 非手术治疗t – these include therapies that are non-invasive and mostly conservative. This type of treatment includes walking aids like crutches, positioning aids like knee immobilizers, bed rest along with medications like NSAIDs (non-steroidal anti-inflammatory drugs) which help to reduce swelling and pain 
  • 手术治疗 – this is the most opted treatment for acetabular fractures. The cartilage around the acetabulum is oftentimes torn which needs to be fixed to avoid complications. During surgery, bones are fixed (joined together if broken into pieces) and aligned into their proper positions. Surgery is also needed if there is a severed vessel that is causing an internal hemorrhage (bleeding) due to the fracture. Your doctor might put metal plates in your joint to keep it fixed until you recover.  
  • Total hip replacement – in cases of severe damage, the acetabulum cannot be fixed. In these cases, total hip replacement surgery is advised. In this procedure, the damaged acetabulum and associated cartilage is removed and replaced by artificial bone and cartilage 

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并发症

髋臼骨折及其治疗有时会导致并发症。其中一些并发症是: 

  • 坐骨神经损伤 – 坐骨神经位于 时髦的 关节,如果损伤严重且广泛,可能会损伤坐骨神经,导致大腿无力甚至瘫痪 肌肉 
  • Post-traumatic arthritis – acetabular fractures often damage the smooth surface of the articular cartilage around the acetabulum, and this can cause joint pain and swelling even after successful treatment 
  • 内出血 – if an artery is cut due to the fracture, internal bleeding can cause a lot of damage and even shock if not treated properly. In some cases of hip replacement surgeries, the femoral artery (artery in your thigh) gets lacerated (cut) leading to high amounts of blood loss which can be fatal.  
  • 感染 – if bacteria enter the body during surgery or through the wound it can lead to infection and even sepsis (an infection spread in the bloodstream) 
  • 缺血性坏死 – femoral head necrosis (tissue death) is a common complication of hip fractures. It can be associated with acetabular fractures too. It occurs due to blocked blood supply to the femoral head (ball) by arterial damage leading to necrosis of the head of the femur 

预防

您可以通过以下方式预防髋臼骨折: 

  • 系好安全带,安全驾驶 
  • 爬梯子时小心放置梯子 
  • 保持健康均衡的饮食,摄入充足的钙和维生素 D 
  • Exercise regularly – this can strengthen your ligaments and joints. This can reduce the severity of fractures 

什么时候去看医生

If you get into an accident or experience a high-impact fall on your legs resulting in severe pain, you need to get medical treatment right away. Along with the pain, you might experience swelling which might be increasing with time. Your doctor will treat you for the pain first and then manage the fractures you had.  

Your recovery period depends on the severity of the injury you had. In case of minor fractures, you would be advised to rest for some time and then start doing light movements. However, in case of severe fractures, you would need to take bed rest for a longer period of time and along with other therapies. Most of the people recover fully and enjoy a healthy life. 

参考

贡献者和/或更新者杰弗里·M·史密斯,医学博士,罗伯特·P·邓巴,医学博士,Jason A. Lowe,医学博士, Jason D. Provus, 医学博士 

· OrthoInfo 的髋臼骨折 - https://orthoinfo.aaos.org/en/diseases–conditions/acetabular-fractures/

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