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髖臼骨折 - 原因、症狀和治療

概述

我們的 時髦的 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. 

解剖學

時髦的 關節是我們身體的一個大而重要的關節。它有助於穩定我們的身體並將軀幹的重量傳遞到腿部。如上所述,它是一種球窩式接頭。髖臼形成承窩,股骨(頭部)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.  

BodyParts3D 由 DBCLS, CC BY-SA 2.1 JP 製作 https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en,通過維基共享資源

體徵和症狀

髖臼骨折的症狀確實因骨折的嚴重程度而異。在某些情況下,髖臼只有輕微的裂縫,而在其他嚴重的情況下,髖臼可能會碎裂成幾塊。像我們身體的其他所有骨折一樣,症狀包括: 

  • 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.

原因和風險因素

當股骨頭對承窩施加巨大的力時,會發生髖臼骨折,最終會破壞承窩。自動碰撞(車禍)是這種力量的主要來源。在事故中,您的膝蓋撞到儀表板或方向盤會通過股骨頭對您的髖臼施加壓力。它也可能是由臀部兩側的直接跌落引起的,迫使股骨頭進入承窩,使其斷裂。 

從事接觸性運動的運動員也可能出現這種骨折,尤其是參加澳大利亞橄欖球、足球和體操的運動員。一些風險因素包括: 

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

診斷

高衝擊性骨折的人幾乎總是在緊急情況下來醫院。在穩定您的疼痛後,您的醫生可能會記錄您的病史,進行體格檢查,並要求一些其他診斷技術來確認您是否患有髖臼骨折。這些診斷技術包括: 

  • X 射線 – X-rays for acetabular fractures are taken from various angles to asses the severity of the fracture. 
  • CT掃描 – it is a commonly ordered scan that provides a more detailed view of the bones in the pelvis and the fractured bones. 
James Heilman,醫學博士,CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0,通過維基共享資源

治療

治療取決於骨折的嚴重程度和模式以及您的整體健康狀況。髖臼骨折有幾種治療選擇: 

  • 非手術治療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 
  • 手術治療 – 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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並發症

髖臼骨折及其治療有時會導致並發症。其中一些並發症是: 

  • 坐骨神經損傷 – 坐骨神經位於 時髦的 關節,如果損傷嚴重且廣泛,可能會損傷坐骨神經,導致大腿無力甚至癱瘓 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 
  • 內出血 – 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) 
  • 缺血性壞死 – 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 

預防

您可以通過以下方式預防髖臼骨折: 

  • 係好安全帶,安全駕駛 
  • 爬梯子時小心放置梯子 
  • 保持健康均衡的飲食,攝入充足的鈣和維生素 D 
  • Exercise regularly – this can strengthen your ligaments and joints. This can reduce the severity of fractures 

什麼時候去看醫生

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. 

參考

貢獻者和/或更新者杰弗裡·M·史密斯,醫學博士,羅伯特·P·鄧巴,醫學博士,Jason A. Lowe,醫學博士, Jason D. Provus, 醫學博士 

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

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