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人工全髋关节置换术治疗石骨症股骨近段骨折内固定术后畸形愈合合并股骨颈骨折一例
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- Author:
- No author available
- Journal Title:
- National Medical Journal of China
- Issue:
- 27
- DOI:
- 10.3760/cma.j.issn.0376-2491.2016.27.019
- Key Word:
- No keyword available
Abstract： 患者男,24岁,14年共3次外伤史,曾2次入院行手术治疗,分别行左股骨近段骨折股骨近端髓内钉(PFN)内固定术及右侧股骨近端骨折钢板内固定术,术后双拐辅助行走后可单拐辅助缓慢行走,3h前自诉行走时不慎摔伤左髋部,感左髋部疼痛不适,活动受限.查体:身高184 cm,体重120 kg,体质指数(BMI) 35.4 kg/m2,方颅,无贫血貌,双髋部外侧股骨侧见陈旧性手术瘢痕,刀口愈合良好,无红热,左髋关节肿胀,左侧髋关节活动查体不合作,右侧髋关节活动度:屈曲95°,伸直5°,外展30°,内收25°,外旋35°,内旋30°,左下肢短缩外旋45°畸形,左髋关节压痛,纵向叩击痛,左髋关节因疼痛无法活动,双髋正侧位X线示:各部骨质密度增高,右侧股骨近段骨折钢板螺钉内固定术后状态,骨折愈合良好;左侧股骨近端骨折PFN内固定术后改变,可见骨折线,左侧股骨颈骨质不连续,左股骨头骨质密度不均匀,骨盆、双股骨及右胫腓骨改变,符合石骨症X线表现(广泛均匀、骨密度增高硬化,骨小梁变粗、模糊,皮质增厚,髓腔狭窄,甚至消失)(图1A ～C).
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