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陶可主治医师 北京大学人民医院 骨关节科 股骨颈骨折内固定失败原因分析:复位不充分伴随固定不牢靠,骨量不足和锻炼不到位,2002年ClinOrthopRelatRes.Youngpatient:Inadequatereductioncloselyfollowedbyinadequatefixation.Olderpatient:Inadequatebonedensityandinadequatepatientreliability.作者:LanceSEstrada,DavidAVolgas,JamesPStannard,JorgeEAlonso作者单位:DivisionofOrthopaedicSurgery,UniversityofAlabamaatBirmingham,15303AvenueSouth,Birmingham,AL35294-3295,USA.译者:陶可(北京大学人民医院骨关节科)摘要与任何其他骨折相比,股骨颈骨折内固定与更高的并发症发生率相关。切开复位和内固定的骨不连和缺血性坏死率仍然高得令人无法接受。这些并发症是在老年患者出现移位骨折的情况下采用原发性股骨头内假体置换的主要原因。然而,随着这些假体患者寿命的延长,股骨头内假体置换的晚期并发症变得越来越严重。对于这些并发症,大多数患者股骨颈骨折最具成本效益的解决方案可能是切开复位内固定,必要时对有并发症的患者进行全髋关节置换术。由于文献没有对内固定失败原因的系统评价,作者将尝试回顾年轻和老年患者内固定失败的常见原因,以更好地了解和预防这些并发症。文献出处:LanceSEstrada,DavidAVolgas,JamesPStannard,JorgeEAlonso.Fixationfailureinfemoralneckfractures.Review,ClinOrthopRelatRes.2002Jun;(399):110-8.doi:10.1097/00003086-200206000-00013.FixationfailureinfemoralneckfracturesAbstractFixationoffemoralneckfracturesisassociatedwithahigherincidenceofcomplicationsthananyotherfracture.Theratesofnonunionandavascularnecrosiswithopenreductionandinternalfixationcontinuetobeunacceptablyhigh.Thesecomplicationsarethemainreasonforresortingtoprimaryendoprostheticreplacementofthefemoralheadinthepresenceofdisplacedfracturesinelderlypatients.However,withtheincreasinglifespanofthepatientswiththeseprostheses,latecomplicationsofendoprostheticreplacementofthefemoralheadarebecomingsignificant.Withthesecomplications,itmaybearguedthatthemostcost-effectivesolutiontothefemoralneckfractureinthemajorityofpatientsisopenreductionandinternalfixation,withelectiveconversion,whennecessary,tototalhiparthroplastyinpatientswhohaveacomplication.Becausetheliteraturedoesnotcontainasystematicreviewofreasonsforfailureofinternalfixation,theauthorswillattempttoreviewthecommonmeansoffailureofinternalfixationinyoungandolderpatientsinanattempttobetterunderstandandpreventthesecomplications.Fig1.AnAPradiographshowsanonreducedfemoralneckfractureinvaruswithscrewthreadsacrossthefractureline.图1.前后位X线片显示内翻未复位的股骨颈骨折,螺纹钉穿过骨折线。Fig2.AnAPradiographofa32-year-oldwomanwithafemoralneckfractureandatransverseposteriorwallacetabularfractureafterahigh-energymotorvehicleaccidentisshow.图2.一名32岁女性在高能量机动车事故后股骨颈骨折和髋臼后壁横向骨折的前后位APX线片。Fig3.AnAPradiographshowsanassociatedfemoralshaftfractureandfemoralneckfracturetreatedwithantegradenailandcannulatedscrewsoutsidethenailfixingthefemoralneckfracture.图3.前后位X线片显示相关的股骨干骨折和股骨颈骨折,使用顺行髓内钉和钉外空心螺钉固定股骨颈骨折。Fig4.Aschematicrepresentationofafemoralneckfracturereducedinvalgus“hatonahook”withgoodpositioningofthescrewsisshown.图4.股骨颈骨折的示意图显示了外翻“帽子上的钩子”复位,螺钉定位良好。Fig5.Aradiographshowsahigh-anglefractureinayoungmalewhohadscrewfixation.Thispatienthadanonuniondevelop.图5.X线片显示一名接受螺钉内固定的年轻男性的大角度(PIII型,股骨颈骨折断端角度大于50度)骨折,该患者出现骨不连。Fig6.AnAPradiographshowsafemoralneckfracturetreatedwithKnowlespinsinanelderlypatient.Thispatienthadavascularnecrosisofthefemoralheaddevelop.图6.前后位APX线片显示用诺尔斯针治疗老年患者的股骨颈骨折。该患者发生股骨头缺血性坏死。2022年02月03日 472 0 2
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