股骨颈骨折:问题及对策

Femoral neck fracture: problems and countermeasures

背景:股骨颈骨折是一种临床上常见的创伤,其死亡率和病残率较高,骨折不愈合和股骨头缺血坏死是其临床治疗中存在的两个主要问题。至今,它的治疗及结果等许多方面仍遗留有许多尚未解决的问题。目的:回顾总结了股骨颈骨折的两种主要并发症发生及防治的研究进展,有助于更好地认识这种损伤并发症发生的机制,对正确选择治疗方法有指导意义。方法:总结并归纳了发表于国内外核心期刊上的关于股骨颈骨折的研究文献。对于有关多发伤或与股骨颈骨折无直接相关的研究文献则不予参考,另外,特别关注股骨颈骨折并发骨折不愈合和股骨头缺血坏死的文献。结果与结论:共检索到241篇文献,对资料进行分析,根据上述筛选标准,并以近5-10年文献为主,排除182篇内容与课题目的不符的文献,纳入59篇。通过对文献的复习可知,股骨颈骨折的发病率高,治疗方法多样,但是,其治疗效果受患者的年龄、骨折类型、骨质情况、伴发疾病等多种因素影响,迄今为止在治疗方法的选择上尚无统一的意见,选择最佳治疗方法并不能只根据骨折的影像学表现和患者的年龄,临床医师必须对影响患者骨折愈合的危险因素进行综合评价,然后再决定采用哪种治疗方法更合适,否则很容易导致治疗失败或引起并发症,增加患者精神上和经济上的负担。因此,股骨颈骨折不仅是一个医学问题,还是一个巨大的社会经济问题,找到一种经济、有效的治疗方法是所有骨科医生所面临的挑战,而骨折内固定加上骨诱导材料的应用可能为进一步提高股骨颈骨折治疗效果指出了新的方向。

BACKGROUND： The femoral neck fracture is a common skeletal injury, with high mortality and disability rate. Nonunion and avascular necrosis in femoral head are the main problems in treatment of femoral neck fracture. Up to now, the guidelines for its management continue to be unsolved and are still evolving. OBJECTIVE： This study aims to summarize the incidence of two femoral neck fracture complications, as well as the advance in prevention and treatment. This work can help to better understand the mechanism of non-union and avascular necrosis, and to choose the optimal management of this fracture. METHODS： Papers in terms of femoral neck fracture published in core periodicals were reviewed. Studies which are not directly related to femoral neck fracture or articles regarding poly-trauma were excluded. Literatures concerning non-union and avascular necrosis after femoral neck fracture were preferred. RESULTS AND CONCLUSION： A total of 241 articles were screened out, and those were mainly published in the last five to ten years. 182 unrelated papers were excluded, and 59 papers were included in the analysis. The femoral neck fracture has a high incidence. Nowadays, there are a variety of treatments for this fracture, but thestability and healing result of fractures depend on many factors, such as age, classification of fracture, general condition of patient, and accompanying diseases. Up to now, the choice of management is still controversial. Imaging representation and patient＇s age are not the main factors for the selection of treatment. Hence, a comprehensive assessment of the risk factors that influence fracture healing is necessary for surgeons to choose an optimal treatment of this fracture. Femoral neck fractures, therefore, represent an enormous socio-economic and medical problem and challenge surgeons to find the cheapest and most effective way to treat them. Internal fixation of the fracture in combination with the use of osteo-inductive materials may be a new way to further improve the treatment effects of femoral neck fracture.