专业从事竞技体操的儿童股骨头特发性无菌性坏死： 临床与X线影像学数据分析

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论证。在专业从事艺术体操训练的儿童中，股骨头骨坏死是一种严重且进展迅速的退行性-营养不良性疾病。该疾病表现为股骨头出现显著破坏性改变，导致髋关节功能明显受限，进而导致疾病结局不佳。髋关节的X线解剖结构特征、在高强度和专业性体育负荷下的疾病发生与发展过程，以及可能导致该疾病晚期诊断和治疗延误的原因尚未得到充分研究。

目的。呈现从事艺术体操的儿童股骨头特发性无菌性坏死患者的临床与X线影像学特征。确定导致晚期诊断和治疗延误的原因。

材料与方法。分析了45例年龄在12至17岁、从事艺术体操训练的股骨头特发性无菌性坏死儿童患者的病史资料和影像学检查结果。

结果。该研究患者多表现出严重的临床病程，这主要由股骨头的全头或亚全头型损害所致。从事专业艺术体操的儿童髋关节解剖结构的显著特征包括：关节呈发育性髋关节发育不良形态，并伴有稳定性指标降低；股骨头呈Kalamchi II型“外翻性形成”变形；同时髋臼存在后倾趋势。这些结构特征促使股骨头更易发生外移和变形，从而加速了病理性改变的发展。导致该疾病晚期诊断和治疗延误的主要原因包括：家长、教练和医生对该疾病的认知不足；临床症状发展逐渐且无明显外伤史；以及在疾病早期阶段患者检查过程中存在漏诊问题。

结论。发现的髋关节先天性解剖结构异常整体加重了该疾病在青少年中的临床过程。对于体操运动员，早期进行髋关节疼痛的差异性诊断极为重要，包括应用磁共振成像检查，以有针对性地排除股骨头骨坏死的可能性。

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作者简介

Ivan Y. Pozdnikin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: pozdnikin@gmail.com
ORCID iD: 0000-0002-7026-1586
SPIN 代码: 3744-8613

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Pavel I. Bortulev

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817
SPIN 代码: 9903-6861

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Dmitrii B. Barsukov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634
SPIN 代码: 2454-6548

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Tatiana V. Murashko

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: popova332@mail.ru
ORCID iD: 0000-0002-0596-3741
SPIN 代码: 9295-6453

MD

俄罗斯联邦, Saint Petersburg

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2. Fig. 1. Comparison of the range of hip motion of the study patients.

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3. Fig. 2. Osteonecrosis stage-based patient distribution according to the Association Research Circulation Osseous classification.

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4. Fig. 3. Hip joint radiographs: a, 15-year-old female patient; b, 12-year-old female patient diagnosed with idiopathic avascular necrosis of the right femoral head. Alterations in the proximal femur of the healthy hip are significant (a, left panel: horizontal position of the epiphyseal growth plate, neck waist), a, “borderline” Wiberg angle, and b, true acetabular dysplasia. Affected side: femoral head extrusion (b, right panel) and decreased distance between the trochanter and the pelvic bone (a, right panel).

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5. Fig. 4. a, b, Radiographs and c, magnetic resonance image of a 14-year-old female patient, who was diagnosed with idiopathic avascular necrosis of the right femoral head; deformity and extrusion of the right femoral head on the right; stage II–III coxarthrosis; c, synovitis, cartilage deformity.

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6. Fig. 5. a, b, Radiographs and с, magnetic resonance imaging image of a 12-year-old female patient, who was diagnosed with idiopathic avascular necrosis of the left femoral head; femoral head deformity (intra-articular) of the affected hip joint (indicated by arrow).

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