大腿骨転子部骨折後早期に発症した大腿骨頭壊死症の1例

Avascular Necrosis of the Femoral Head after Treatment of an Intertrochanteric Fracture. Case Report

　大腿転子部骨折術後に大腿頭壊死を発症した非常に稀な1例を経験したので報告する．症例は52歳の男性で，アルコール多飲歴を認めた．単純X線像で左大腿転子部骨折を認め，骨接合術を施行した．術後3カ月の単純X線およびMRI像で大腿頭壊死を認め，人工骨頭置換術を施行した．大腿転子部骨折術後の骨頭壊死の原因はこれまで，様々な要因が挙げられているが，本症例はアルコール多飲歴の関与が疑われた．大腿頭壊死を来す因子を有する症例が大腿転子部骨折を受傷した場合，術前にMRIでの壊死の有無の判定が必要であると考える．

　Avascular necrosis of the femoral head is a rare complication after treatment of intertrochanteric fractures.　We report a case of femoral head necrosis after surgical fixation with a short femoral nail.　The patient was a 52-year-old alcoholic man with an intertrochanteric fracture diagnosed by X-ray who was treated by internal fixation with a short femoral nail.　Three months after the operation, X-ray and MRI images revealed femoral head necrosis, and it was treated by bipolar arthroplasty of the femoral head.　Several causes of femoral head necrosis have been described in previous reports, and alcoholism was probably a predisposing factor in our patient.　We consider it necessary to perform MRI to screen intertrochanteric fracture, patients who are at a high risk for femoral head necrosis, e.g., patients who are alcoholic or on steroid therapy, for possible femoral head necrosis prior to performing internal fixation.