同时累及同侧股骨颈与转子间两个解剖区域的骨折类型与研究进展

Patterns and research progress on the concomitant ipsilateral fractures of intracapsular femoral neck and extracapsular trochanter

目的总结同时累及同侧股骨颈与转子间两个解剖区域骨折的相关研究进展,归纳骨折分型。方法查阅国内外相关文献并结合自身经验,从股骨颈与转子间的解剖分界、股骨转子间线及关节囊附着、临床分型、治疗方法选择等方面进行分析总结。结果同时累及同侧股骨颈与转子间两个解剖区域的股骨近端粉碎骨折,在老年髋部骨折人群中比例有逐渐增高趋势,但其概念和含义并不明确。按股骨颈骨折的部位、骨折中心位置和骨折复位后股骨距或前内下角皮质能否直接接触砥住,可以将其分为3种亚型:①节段性股骨颈骨折(股骨颈为头下型骨折,同时具有两个独立的骨折中心);②股骨颈骨折向转子间外上方延伸(股骨颈为经颈型骨折,一个骨折中心);③股骨转子间粉碎骨折向股骨颈内下方延伸(粉碎的股骨颈基底型骨折,转子间骨折变异类型,一个骨折中心)。在治疗上需兼顾两个解剖部位特征,通常需结合多种内固定方法或采用关节置换辅助内固定技术,才能获得较好效果。结论同时累及同侧股骨颈与转子间两个解剖区域的骨折,在临床诊断、骨折分型和治疗方法上尚缺乏共识,需进一步研究。

Objective To summarize the patterns and research progress of the concomitant ipsilateral fractures of intracapsular femoral neck and extracapsular trochanter,and to provide a common language among orthopedic surgeons for scientific exchange.Methods According to related literature and authors own experiences concerning the anatomic border between femoral neck and trochanter region,the intertrochanteric line(or intertrochanteric belt)and its capsularligament attachment footprint,fracture patterns,and treatment strategies were reviewed and analyzed.Results With the rapid growing of geriatric hip fractures,an increased incidence was noted in recent years regarding the proximal femoral comminuted fractures that involving ipsilateral intracapsular neck and extracapsular trochanter regions simultaneously.But the concept of femoral neck combined with trochanter fractures was ambiguous.Based on the anatomic type of femoral neck fracture,the location of fracture center,and the ability to achieve direct inferior calcar or anteromedial cortex-to-cortex apposition and buttress,we classified these complex fractures into 3 sub-types:①Segmental femoral neck fractures(two separate fracture centers at subcapital and trochanteric region respectively);②Femoral neck fracture(trans-cervical)with extension to the supero-lateral trochanteric region(fracture center in femoral neck);③Trochanteric fracture with extension to the medio-inferior femoral neck region(fracture center in trochanter,comminuted basicervical fracture,or variant type of comminuted trochanter fracture).For treatment strategy,surgeons should consider the unique characteristics of femoral neck and trochanter,usually with combined fixation techniques,or arthroplasty supplemented with fixation.Conclusion Currently there is no consensus on diagnosis and terminology regarding the concomitant ipsilateral fractures of femoral neck and trochanter.Further studies are needed.