Femoroacetabularni impingement usled neanatomskog zarastanja kod preloma vrata butne kosti
Sažetak
Apstrakt
Uvod. Femoroacetabularni poremećaj je rezultat patoloških stanja u acetabulumu i/ili proksimalnom femuru. Jedan od njegovih uzroka je i ne-anatomski zarastao prelom vrata femura. Prikaz bolestnika. Muškarac, star 51 godinu, sa subkapitalnim prelomom vrata leve butne kosti, lečen je konzervativno. Prelom je zarastao tek devet meseci kasnije. Pacijent je hodao na štakama i patio od bolova u predelu levog zgloba kuka. Rendgenske slike pokazale su valgus i retropoziciju leve femoralne glave. Pacijent je bio operisan i intraoperativno je nađeno zadebljanje u anterosuperiornom delu vrata butne kosti u nivou linije prethodne frakture. Ovo zadebljanje vršilo je pristisak i destrukciju acetabularne hrskavice i labruma. Lezija labruma koja je bila pronađena, bila je rezultat mehaničkog pritiska postojećeg deformiteta vratnog dela femura tokom kretanja kuka. Nepovratno oštećeni deo labrum-a je reseciran i urađena je osteohondroplastika anterosuperiorne femoralne glave i vrata. Godinu dana nakon operacije, pacijent je bio bez bolova, hodao je bez hramanja, a impingement test bio je negativan. Radiološki parametri bili su popravljeni i nije bilo znakova avaskularne nekroze femoralne glave. Zaključak. Frakturu vrata butne kosti treba adekvatno lečiti punom anatomskom repozicijom i pravilnom unutrašnjom fiksacijom. Ako se deformacija javlja kao rezultat lečenja, treba je ukloniti što je pre moguće kako bi se sprečio osteoartritis kuka.
Reference
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