髂前下棘的解剖学研究及其在骨盆骨折中的应用

目的对髂前下棘及其体表投影进行应用解剖学研究,为骨盆骨折微创置入外固定钉提供参考依据。方法观察15具尸体30侧骨盆髂前下棘及体表投影,测量髂前下棘横径、矢状径和体表投影,按性别分组进行统计学处理。结果男性髂前下棘矢状径和横径分别为(26.51±2.86)mm和(11.64±1.15)mm;女性分别为(25.46±3.92)mm和(9.20±1.14)mm。男性髂前上棘到髂前下棘体表投影的距离对髂前上棘与耻骨结节间距离的回归系数为0.252;女性为0.262。结论髂前下棘的体表投影点位于髂前上棘与耻骨结节连线的外上1/4处,了解这一特点有助于准确置入骨盆外固定钉。     

自行车把伤致髂前下棘骨折1例

患者，男，40岁。2009年9月9日骑自行车行驶时发生碰撞，被自行车把戳伤左髂部，伤后因剧烈疼痛来院就诊。查体：左腹股沟部肿胀淤血，皮肤青紫，左髋关节活动受限。摄骨盆正位X线片示：左髂前下棘骨折伴分离移位（图1）。于2009年9月11日予切开复位可吸收螺钉内固定治疗。     

关节镜治疗合并棘下撞击的髋臼盂唇损伤患者临床疗效评价

目的 探讨合并棘下撞击的髋臼盂唇损伤患者的临床特征并对髋关节镜术后疗效进行评价.方法 选择2019年9月至2020年6月我院诊断为合并棘下撞击的髋臼盂唇损伤患者30例,其中男12例,女18例;年龄18～56岁,平均(32.8±10.8)岁.30例患者在髋关节镜下行盂唇修复术、髂前下棘成形术及股骨成形术.术前利用X线片、...     

髋关节镜手术治疗合并髂前下棘棘下撞击的髋臼股骨撞击症

目的探讨髋关节镜手术治疗合并髂前下棘棘下撞击的髋臼股骨撞击症(femoroacetabular impingement, FAI)的临床疗效。方法回顾性分析2021年8月至2022年5月收治的随访1年以上的合并髂前下棘棘下撞击的FAI患者23例(23髋), 男10例、女13例, 年龄(31.3±4.6)岁(范围25～45岁), 左侧9例、右侧14例, 合并2型髂前下棘20例、3型髂前下棘3例。在常规髋臼缘成形、股骨头颈成形、盂唇缝合的基础上, 同时进行髂前下棘(anterior inferior iliac spine)成形棘下减压术。比较术前和术后1年随访时骨盆正位X线片LCE角、屈髋45°Dunn位X线片α角、髋关节最大屈曲角度、屈髋和伸膝肌力、疼痛视觉模拟评分(visual analogue scale, VAS)、改良Harris评分(modified Harris hip scores, mHHS)、国际髋关节评分(international hip outcome tool-12, iHOT-12)。结果术后1年随访时无一例行髋关节镜或开放的翻修手术。LCE角由术前33.3...     

髂骨取骨术后继发髂前下棘骨折一例

正病人,男性,29岁。扭伤致左髋部疼痛、肿胀伴活动受限5小时于2019年7月5日入院。X线检查提示左髂骨取骨术后改变,不能排除新发骨折可能(图1)。CT检查提示左侧髂骨部分缺如(图2)。查体可见左侧髂脊可见一长约30cm手术瘢痕切口,左髋部稍肿胀,局部压、叩痛明显,左髋部因疼痛活动受限,     

髂前下棘进钉结合外固定支架在治疗骨盆骨折中的运用

目的通过髂前下棘进钉结合外固定支架对骨盆骨折进行复位和固定治疗,探讨其临床意义。方法采用此方法治疗骨盆骨折19例。结果术后随访时间平均12个月,骨折均愈合;钉道感染14例,螺钉均无松动,拆除螺钉换药后均愈合;1例存在骨折复位部分丢失。结论本法治疗骨盆骨折对病人创伤小,可避免对创伤患者二次打击,固定较牢固,复位满意,可以满足病人早期活动。     

髋关节前脱位合并髂前上下棘骨折一例报告

髋关节前脱位合并髂前上下棘骨折一例报告袁天祥赵文宽髋关节前方的骨折脱位，其发生率明显低于髋关节后方的骨折脱位。Ｌｅｔｏｕｒｎｅｌ统计手术治疗的髋臼骨折脱位，前后比例为１∶５。前脱位发生时，根据股骨头脱出的位置，一般分为三种情况：即股骨头脱于耻骨部、闭...     

青少年髂前上棘撕脱骨折的诊治探讨

[目的]探讨青少年髂前上棘撕脱骨折的发病原因及诊疗方法。[方法]上海儿童医学中心骨科2001年1月-2006年1月共收治了15例骨盆髂前上棘撕脱骨折病例，男14例，女1例，年龄12—16岁，急性14人，慢性1人；10例发生在短距离赛跑时，2例发生在足球运动时，各有1例发生在排球、篮球和棒球运动时；X线片和CT检查可以明确诊断并根据撕脱骨片的大小及移位的方向及距离，分别采用切开复位内固定、外展屈髋位石膏固定、卧床休息等不同治疗方法。[结果]14例急性病例，保守及手术治疗效果优良，均达到局部无疼痛，髋关节满幅活动，步态正常，可参加各类体育活动。1例慢性病例为外院保守治疗2个月后转来，局部仍明显疼痛，经本院手术治疗后效果满意。作者认为手术复位内固定者可达到解剖复位，康复时间短，早期活动。[结论]明确髂前上棘撕脱骨折的病因、分类，可以做到正确诊断，合理治疗，早期康复，杜绝各种不良后果。     

髂前上棘骨折15例

髂前上棘骨折一些学者以保守治疗为主，也有一些专家认为应保守与手术疗法相结合，少数主张手术内固定。自1998年6月—2003年1月共诊治该类骨折15例，通过保守治疗与手术治疗，收效较好，特报告如下。     

经皮穿针治疗髂前上棘骨折17例

髂前上棘骨折临床少见,自2000-2004年,我们采用经皮钢针挑拨复位固定的方法治疗此类损伤17例,取得满意的效果,现总结报告如下。1临床资料本组17例,男13例,女4例;年龄15~39岁,平均23·6岁。14例为运动损伤,3例为外力打击伤。受伤时间2h~5d。术前均拍X线片证实。2治疗方法取仰卧位,在局部麻醉下进行,局麻成功后,将患侧下肢屈髋屈膝,术者站于患侧,用手扪及髂前上棘骨块及髂前上棘撕脱处,先手法推挤髂前上棘骨块,使之复位。若复位困难,可选择1枚直径2mm的钢针经皮穿入骨块,用钢针向髂嵴方向挑拨骨块,同时用手向上推挤骨块使之复位,另选择1枚直…     

Operative treatment of avulsion fractures of the anterior inferior iliac spine: a two-case report

Abstract Avulsion fractures of the anterior inferior iliac spine (AIIS) are rare injuries of the pelvic ring. In two male athletes this injury was missed during initial examination and therefore was not treated optimally. Six months after the initial injury, the patients felt constant pain, and there was a lump in the thigh region; they both also had limited range of hip motion. Therefore, radiography and magnetic resonance imaging of the hip were performed. Avulsion fracture of AIIS was diagnosed and treated surgically with excision of the avulsed fragment. Two years later, both athletes have completely recovered and returned to their usual sporting activities. Isokinetic muscle testing disclosed that the extensor muscles of the operated side of the knee were weaker than those on the uninjured side.     

双侧髂前上棘撕脱骨折1例

患者，男，18岁，学生，以“双侧髂前上棘肿痛1周，加重1d”就诊。1周前患者上体育课跑步后感双髂前上棘处疼痛，当时未予重视，休息后稍缓角，1d前再次参加田径比赛后出现双侧髂前上棘处疼痛加重，拒按，肿胀明显，双正肢伸直时疼痛加剧，行走困难，以肌肉拉伤外搽消肿止痛酊治疗，体息后症状不缓解，遂来我院求治。     

Avulsion fracture of the anterior superior iliac spine: misdiagnosis of a bone tumour

Avulsion fractures of the anterior superior iliac spine are rare. This injury is usually seen in adolescents, as an avulsion fracture of the apophyses, a result of sudden vigorous contraction or repetitive contraction of the sartorius and tensor fasciae latae muscles. Treatment for this injury is usually conservative; however, surgical management has been reported in those with significant displacement. We present a 14 year old male patient who was referred to our unit for biopsy of a possible pathological fracture of his right ilium. The authors feel it is essential to understand the importance of ruling out a bone tumour, if the possibility has been raised, before managing a suspected fracture. If there is any doubt, the case should be referred to an appropriate sarcoma unit for review prior to any intervention.     

手术治疗髂前上棘骨骺撕脱骨折6例

自2004年10月-2005年12月采用手术治疗髂前上棘骨骺撕脱骨折6例,现总结报告如下。1临床资料本组6例,男5例,女1例;年龄12～16岁,平均14.2岁。左侧2例,右侧4例;均为运动会50～100m短跑时受伤,其中2例为起跑时受伤,4例为最后冲刺时受伤。受伤至就诊时间1～3h,平均2h。患者均主诉在     

Subspine Hypertrophy: Higher Incidence of Symptomatic versus Asymptomatic Hips in Patients with Unilateral Femoroacetabular Impingement

ObjectiveTo compare the difference of anterior inferior iliac spine (AIIS) and subspine hypertrophic deformity between symptomatic and asymptomatic hips in patients traditionally diagnosed with femoroacetabular impingement (FAI), and investigate the correlation of subspine decompression with AIIS variation and subspine hypertrophic deformity.MethodsWe retrospectively reviewed 70 patients with unilateral symptomatic FAI who underwent hip arthroscopy. The operative hips and contralateral hips naturally formed the symptomatic groups and asymptomatic control groups, respectively. The morphometric comparison of the hip joint was performed between the operative and contralateral sides of each patient. Radiological assessment was performed by two observers (an experienced musculoskeletal radiologist and an experienced surgeon). Three‐dimensional (3D)‐CT images of each patient were blindly reviewed to determine the AIIS variation and subspine hypertrophic deformity. Reformatted two‐dimensional (2D)‐CT images and anterior–posterior (AP) pelvic plain radiographs were blindly reviewed to determine FAI‐related morphological measurements. Moreover, the surgical assessment was reviewed by one experienced surgeon to interpret whether subspine decompression was performed. The correlation of subspine decompression with AIIS variation and subspine hypertrophy was analyzed.ResultsOut of 70 patients with unilateral symptomatic FAI, 37 were males (52.9%) and 23 (32.9%) had symptoms involving the left hip. The mean age was 39.3 ± 10.4 years and the mean BMI was 24.3 ± 3.6. The distribution of AIIS variants in symptomatic hips did not differ significantly from that in asymptomatic hips (χ² = 3.092, P = 0.213). Twenty‐nine hips in the symptomatic group (41.4%) and 12 hips in the asymptomatic group (17.1%) were identified as positive for subspine hypertrophy. The incidence of positive subspine hypertrophy was significantly higher in the symptomatic hips compared to the asymptomatic hips (χ² = 9.968, P = 0.002). FAI‐related morphological parameters including α angle, lateral center‐edge angle, acetabular anteversion, crossover sign, and Tonnis grade were highly symmetrical and did not show significant differences between symptomatic and asymptomatic hips. Fifty‐four of 70 hips (77.1%) had labral tears extended to the acetabular rim corresponding to the AIIS. Forty‐seven hips of 70 hips (67.1%) underwent subspine decompression, which was significantly correlated with AIIS variation and subspine hypertrophic deformity (P = 0.019 and 0.001, respectively).ConclusionSubspine hypertrophic deformity was found to be more common in symptomatic side vs asymptomatic side in patients with unilateral symptomatic femoroacetabular impingement. Subspine hypertrophy may be considered as an underlying indication for subspine decompression besides low‐lying AIIS.     

不可吸收缝线治疗髂前上棘撕脱性骨折

正2012年7月~2015年10月,我们采用不可吸收缝线治疗11例髂前上棘撕脱骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组11例,均为男性,年龄11~16岁。就诊时可见患者轻度屈髋体位,髂前上棘处肿胀、压痛。受伤至手术时间4 h~5 d。1.2治疗方法全身麻醉下手术。患者仰卧,患肢稍屈髋屈膝外旋位。以髂