成年人不需麻醉即可自行復位之創傷性髖關節脫臼：罕見案例報告和文獻探討

Spontaneous Reduction of Traumatic Hip Dislocation in Adult without Post-reduction Associated Injury: A Rare Case and Literature Review

介紹：由於髖臼周圍的骨頭構造特性加上能夠加深髖臼深度的髖臼唇等構造，使得髖關節成為一個需要一個相對大的外力才能造成脫臼的關節。大部分發生在年輕人的創傷性髖關節脫臼是由於高能量撞擊而形成。我們在此報告一例非常罕見的病例。這位病人在發生髖關節脫臼後並沒有施行任何的麻醉即可靠病人本人自己的姿勢改變而自行復位成功併且關節周圍沒有發生任何的骨折.
病例報告：這是一位22歲的年輕男性，他騎著機車不幸的發生了車禍。我們一開始依照ATLS的標準先給予病人緊急處置。在生命徵象穩定後，我們安排影像學檢查發現病人有顱內出血，氣血胸，多根肋骨骨折和左髖關節脫臼。由於病人有髖關節脫臼的問題，我們在安置完胸管後準備給予髖關節復位。正當我們計劃施打麻醉鎮靜藥物之前，病人就已經靠自己的力量把脫臼復位。接著我們幫病人做骨盆腔電腦斷層掃描，發現髖關節周圍沒有任何骨折且已經達到解剖復位。根據Stewart-Milford 分類是屬於Type I Dislocation。病人沒有產生任何神經血官的併發症且髖關節在復位後是屬於穩定的狀態。
結論：根據我們過去的知識，能夠單靠病人本身自行復位的創傷性髖關節脫臼並沒有被報告過。一旦發生很容易會被忽略進而造成因延遲診斷而產生的嚴重併發症，例如: 股骨頭缺血性壞死。對於這一類的病人，我們要時常保持警覺性去懷疑病人是否有發生自行復位性脫臼的可能性。這可以讓我們提早在病人發生臨床症狀和影像學變化前給予處置。

Introduction : The hip is a stable joint that requires a significant force to cause dislocation. Traumatic dislocation of the native hip joint frequently occurs in younger patients as a result of high-energy impact. The aim of this case report is to highlight the rare mechanism of spontaneous concentric reduction of hip, without any manipulation or anesthesia, in an agitated patient with multiple trauma.
Case report : A twenty-two-year-old male patient suffered from left-hip dislocation with multiple trauma after a high-energy motorcycle traffic accident. His left hip was fixed at flexion and internal rotation. Pelvis radiography revealed left-hip posterior dislocation. Unexpectedly, spontaneous concentric reduction of left hip occurred two hours after arrival at the emergency department. He was able to perform full range of motion with the left hip without limitation. The post-reduction pelvic CT showed the reduced left hip without femoral head or acetabular fracture. This case was type I dislocation according to Stewart Milford classification.
Conclusion : Spontaneous reduction of the hip joint is very rare and easily neglected if the clinician does not pay particular attention to it initially. Its prognosis is still unclear and more cases are needed in the future for more thorough understanding.