股骨颈骨折内固定后股骨头坏死发生研究现状

Research progress of the osteonecrosis of the femoral head after internal fixation for femoral neck fractures

背景:股骨颈骨折内固定后股骨头坏死等内固定后并发症一直是困扰广大临床医生的一个棘手的问题。目的:分析近15年来关于股骨颈骨折患者行空心钉内固定术后发现股骨头坏死的文献资料,总结其发病流行病学、病因、诊断、治疗以及康复的最新研究进展。方法:搜索CNKI、万方、维普、Pub Med、Medline、Web of Science数据库,以"股骨颈骨折"、"内固定"、"股骨头坏死"、"空心钉内固定"、"坏死"、"femoral neck fracture"、"osteonecrosis of femoral head"、"necrosis"、"internal fixation"、"internal fixationwith cannulated screw"等主题词检索,最后在所获得的文献中排除综述、个案报道等类型文章。结果与结论:(1)共纳入54篇文献关于股骨颈骨折内固定后发现股骨头坏死的文献,发病率为8.1%-37.2%,发现坏死的时间平均为伤后17个月;(2)坏死原因与年龄、术前骨折移位情况、术前牵引、术中骨折复位程度、受伤到手术时间、老年患者合并疾病、老年患者取内固定物、闭合还是切开内固定、术后下地时间、高BMI、高血脂症、季节、抑郁状态等因素相关;(3)治疗可采取预防坏死和坏死后补救手术;(4)术后康复建议患者术后3-6个月不负重下地活动,有利于患者功能的恢复;(5)结果提示,选择适当的手术治疗和术后康复方案,即通过合理的术前规划、规范的手术操作、正确的诊断治疗,恰当的术后康复以及充分的医患合作达到减少股骨颈骨折术后股骨头坏死率发生以及治疗坏死的目的。

BACKGROUND： Osteonecrosis of the femoral head （ONFH） following internal fixation of femoral neck fractures is difficult to be cured in clinic.OBJECTIVE： To analyze the literatures concerning ONFH in patients with femoral neck fractures treated with screw internal fixation in recent 15 years, and to summarize the research progress in views of epidemiology, etiology, diagnosis,treatment and rehabilitation.METHODS： Databases of CNKI, WanFang, CqVip, PubMed, Medline, Web of Science were searched with the keywords of ＂femoral neck fracture, osteonecrosis of femoral head, osteonecrosis, internal fixation, internal fixation with screw＂ in English and Chinese, respectively. Afterwards, the reviews and case reports were excluded. RESULTS AND CONCLUSION： （1） A total of 54 eligible articles addressing the ONFH following internal fixation for femoral neck fractures were included, and the incidence of ONFH varied from 8.1% to 37.2%, which was found at an average of 17 months after injury. （2） ONFH was found to be related to age, preoperative fracture displacement, preoperative traction,reduction condition, time from injury to operation, elderly patients companied with other diseases, older patients undergoing removal of the screws, closed or open internal fixation, restored time postoperatively, high body mass index, hyperlipidemia, season, and depression. （3） Early prevention and remedial surgery were used to treat ONFH. （4） The patients without weight-bearing activities at 3-6 months postoperatively could be beneficial for functional recovery. （5） These results suggest that choosing appropriate surgical programs and rehabilitation plan can reduce the incidence of ONFH and achieve good treatment outcomes, such as reasonable preoperative planning, standardized operation skills, correct diagnosis and treatment, proper postoperative rehabilitation and good doctor-patient cooperation.