- 期刊
Transient Osteoporosis of the Hip during Pregnancy: A Case Report
懷孕期間髖關節一過性骨質疏鬆症：病例報告
摘要
懷孕期間的髖關節疼痛並非罕見的問題，但疼痛程度足以影響行走的卻是少數。本文報告一位36歲的健康婦女，她在孕期的第8個月開始感到兩側的髖關節疼痛，並影響到步行的能力。產後疼痛的情況加重，照過X光之後確定沒有骨折等問題，抽血檢查以及肌電圖檢查都得到正常的結果，在懷疑缺血性壞死(avascular necrosis)的情況下安排了髖關節的核磁共振造影(MRI)檢查，結果發現兩側股骨頭及股骨頸的骨髓水腫(bone marrow edema)，符合一過性骨質疏鬆症(transient osteoporosis)的診斷。這個症狀首先在1959年被提出。其致病原因不明。主要出現在兩個主要的族群，其一是懷孕最後三個月的婦女，其二是過重的中年男性。症狀通常開始於髖部的疼痛，之前並無外傷，體檢可能會發現輕微的關節活動限制。其診斷的確立要先排除其他可能的髖部疼痛原因，例如缺血性壞死，骨折以及腫瘤。核磁共振造影是最好的診斷工具。這是一種自限性的疾病，通常會在2到12個月之內自行好轉。目前尚無任何藥物或治療確定可以影響其病程。骨折是其最嚴重的併發症，故減輕患側的負重，並避免在骨質減少的期間產生骨折是應該注意的地方。這種罕見疾病在亞洲地區尤其少見，這是台灣首位被報告的病例。
並列摘要
Transient osteoporosis, also called ”bone marrow edema syndrome”, is a rare disorder of unknown etiology. It primarily affects women in the third trimester of pregnancy as well as middle-aged, overweight men, and the hip joint is most commonly involved. The main symptom of transient osteoporosis of the hip is a sudden onset of pain at the lateral aspect of the hip. Mild limitation of hip range of motion is often present. A 36-year-old woman presented to our outpatient department 5 weeks after cesarean section with bilateral hip pain, which had begun suddenly during her eighth month of pregnancy. Magnetic resonance imaging of the pelvis revealed marked bone marrow edema at both femoral heads and necks. According to history, physical examination and image findings, transient osteoporosis of the hip was diagnosed. Bone densitometry revealed osteopenia. The patient was begun on a regimen of analgesic medication and physical therapy, and she resumed ambulation 3 months after the cesarean section. Arriving at an accurate diagnosis of this disorder requires ruling out other possible causes of hip pain, including avascular necrosis, stress fracture of the femoral neck, and neoplasia. Early diagnosis is important to prevent possible complications such as fracture.