股骨頸疲勞性骨折：二例報告

Stress Fracture of Femoral Neck: Report of Two Cases

疲勞性骨折在軍中及運動員發生的機率頗高，部位以脛骨最多。而疲勞性骨折一旦發生在股骨頸，若延誤診斷及治療，導致移位，恐有嚴重後果，常常有股骨頭缺血性壞死、內翻變形、或未癒合的後遺症發生。股骨頸疲勞性骨折可分為壓縮型、張力型、及移位受三種分類，治療過程各異，預後亦大不相同。本文將報告二位年輕男性新兵，入伍數月後產生髖部疼痛，曾求助於診所，經服藥及保守治療後症狀仍未改善，一位經轉診至本院骨科門診，X光並無不正常，後予以核醫骨掃描，及早診斷出其罹患股骨頸疲勞性骨折，經住院予以保守治療達到成功的療效；另一位不幸已經發生移位性骨折送至急診，緊急手術內固定後，仍在一年後發生了股骨頭缺血性壞死，最終接受人工關節置換的悲劇。本文之目的在提醒臨床醫師們對股骨頸疲勞性骨折的認識以提高警覺。

Stress fractures of the femoral neck are uncommon injury and are often present with groin or hip pain. The diagnosis is easily missed if physician did not pay much attention. Fullerton classified the stress fractures of the femoral neck into compress,tension and displaced type. If displacement of stress fracture of the femoral neck developed,serious complication such as avascular necrosis of femoral head, varus deformity and nonunion may occur even operation was done. Here,we present two young soliders with stress fractures of the femoral neck, The first case was a victim of compression type of stress fracture of left femoral neck, presenting with left hip pain and early diagnosis by bone scan at our hospital. Successful conservative treatment was noted. Another case with a tension type of stress fracture of the right femoral neck. He was missed diagnosis at local medical clinics and leading to a disastrous complication last. It is important to suspect this diagnosis in young active individuals who recently have performed vigorous repetitive activity, or had an increase in frequency or duration of recurrent activity complain of hip pain.