基于杠杆支点重建理论股骨颈骨折内固定的治疗策略

Therapeutic strategies for internal fixation of femoral neck fractures based on leverage fulcrum reconstruction theory

内固定手术治疗股骨颈骨折的目的是保髋,且使骨折得到良好的复位和固定。通过回顾了股骨颈骨折的分型及内固定治疗现状,发现现有内固定技术的发展并不能有效避免股骨颈短缩、退钉、螺钉切出、内固定断裂等相关并发症,多种临床分型方法在指导内固定方式选择时尚有不足,而滑动板钉和空心钉治疗在不同骨折分型中的疗效也尚存在争议。目前,缺乏合适的理论来解释这些并发症的发生并对其进行预防。基于杠杆支点重建理论,通过结合股骨近端解剖结构及其生物力学特点,揭示内固定相关并发症的发生原因,并为股骨颈骨折的内固定治疗提供建议。杠杆支点重建理论解释了以往治疗后发生内固定并发症的原因,同时基于此理论推荐的治疗方案具有潜在的临床意义,为股骨颈骨折内固定治疗提供了新的理念。

The objective of internal fixation is to preserve the hip and to reduce and fix the fracture.By reviewing the classifications of femoral neck fracture and the current status of internal fixation,we found that the existing internal fixation technology development cannot effectively avoid the occurrence of its related complications such as femoral neck shortening,nail withdrawal,screw removal,internal fixation fracture and so on.Multiple clinical classification methods are insufficient in guiding the selection of internal fixators.Meanwhile,the curative effects of sliding hip screw and cannulated compression screw in different fracture classifications are still controversial.Currently,there is a lack of appropriate theory to explain the occurrence of these complications and to prevent them.In this article,Based on the perspective of lever fulcrum reconstruction theory,Combined with the anatomical structure and biomechanical characteristics of proximal femur,the causes of complications related to internal fixation were revealed,and some suggestions were provided for the treatment of femoral neck fracture.The theory of lever fulcrum reconstruction explains the causes of internal fixation complications after previous treatment,and the treatment scheme recommended based on this theory has potential clinical significance,which provides a new concept for the treatment of femoral neck fracture.