股骨颈骨折内固定器置入的生物力学特征及其应用特点

Vitodynamics and application of internal fixation instrument in treating femoral neck fracture

目的:总结和分析内固定器械在股骨颈骨折治疗中的应用的特点。资料来源:应用计算机检索OVID数据库1996-01/2006-12关于股骨颈骨折的内固定器械方面的文章,检索词“femoral neck fracture,vitodynamics,internal fixation,instrument”并限定文章的语言种类为“English”;利用计算机检索中国期刊全文数据库1996-01/2006-12与股骨颈骨折的内固定器械相关文章,限定文章语言种类为中文,检索词为“股骨颈骨折,内固定器械”等。同时手工查阅相关的书籍。资料选择:共收集到相关文章150余篇,对资料进行初审,纳入标准:①内固定器械应用的特点。②回顾调查研究。③观察对象为股骨颈骨折患者。④无论有无对照组、是否随机均纳入。资料提炼:共收集符合上述要求的文章58篇,进一步查找全文,并阅读其引文,排除重复性研究,内容重复的,以近3年发表,且发表在较权威性杂志者优先,最后纳入26篇进行综述。26篇中8篇论述股骨颈骨折的发病及治疗特点,16篇介绍股骨颈骨折内固定器械的置入特点。资料综合:①股骨颈特殊的解剖关系和血供系统使骨折部位常承受较大的剪应力,从而影响骨折复位和复位内固定后的稳定性。加之骨折时易使血供来源破坏,影响复位和内固定效果,并可能导致骨折不愈合和股骨头缺血性坏死。影响股骨颈骨折预后的医源性因素主要是复位和内固定质量。②用于股骨颈骨折的固定器械装置有多种,折尾钉、空心钉、三刃钉、滑钉或钉板、加压单钉和加压多钉较常用。早期解剖复位、骨折加压、坚强内固定来促进骨愈合。③绝大多数骨科工作者采用空心钉内固定的方法治疗股骨颈骨折。3枚空心加压螺钉固定是目前较为理想的内固定术式。结论:可采用早期解剖复位、骨折的加压、坚强的内固定来促进股骨颈骨折后的骨愈合;目前绝大多数学者采用空心钉内固定的方法治疗股骨颈骨折。

OBJECTIVE： To summarize and analyze the application characteristics of internal fixation device in treating femoral neck fracture. DATA SOURCES： Articles dated between January 1996 and December 2006 with the keywords of ＂femoral neck fracture, vitodynamics, internal fixation, instrument＂ were searched in computerized online database of OVID. Meanwhile, we searched Chinese Journal FuU-text Database for related Chinese articles published from January 1996 to December 2006 with the keywords of ＂femoral neck fracture, internal fixation instrument＂ in Chinese. The related books were also manually searched. STUDY SELECTION： More than 150 articles were collected. The data were firstly selected, and articles that were ①about the application features of internal fixation instrument, ②retrospective survey study, ③of patients with femoral neck fracture as the subjects, ④and regardless of having control group or not, and randomized trail or not were included. Repetitive studies were excluded. DATA EXACTION： Totally 58 articles were collected, and the full-text was looked up. The repetitive studies were excluded; as to those with identical content, the articles published in recant 3 years and in authorial journals were preferred. Finally, 26 were selected for review involving 8 about the onset and treatment of femoral neck fracture, and 16 about the implanting features of the internal fixation instrument for treating femoral neck fracture. DATA SYNTHESIS： ①The anatomical association and blood supply of femoral neck make the fracture site endure huge sheer stress force, and accordingly affect the reduction and stability of internal fixation. Moreover, the blood supply is readily damaged when fracture, which could affect the reduction and internal fixation, and lead to disunion and ischemic necrosis of femoral head. ②Femoral neck fracture is difficult to treat due to the specific anatomical association and blood supply of femoral neck. The iatrogenic factors that could affect the prognosis of femoral neck fracture mainly refer to reposition and quality of internal fixation. Of the various internal fixation instruments for femoral neck fracture, broken caudal screw, cannulated screw, triflanged nail, sliding nail, and compression screw are the common ones. ③Early anatomical reduction, compression fracture, and compression internal fixation are used to promote bone healing. Most of orthopedics workers like treating femoral neck fracture by internal fixation with cannulated screw. Three cannulated compression screw fixation is an ideal internal fixation at present. CONCLUSION： Eady anatomical reduction, compression fracture, and compression internal fixation could promote bone healing in femoral neck fracture. Currently, cannulated screw fixation is a favorable approach to treat femoral neck fracture by most scholars.