青壮年股骨颈骨折内固定后股骨头坏死的发病机制

Pathogenesis of femoral head necrosis after internal fixation of femoral neck fractures in young adults

背景:青壮年股骨颈骨内固定后并发股骨头坏死的预防在骨科领域仍是一项挑战,针对青壮年股骨颈骨折内固定术后并发股骨头坏死的发病机制仍是充满讨论的话题。目的:对青壮年股骨颈骨折内固定后股并发股骨头坏死的发病机制做一综述。方法:通过计算机检索2010-2021年PubMed、EMbase、万方数据库、维普和中国知网上关于青壮年股骨颈骨折内固定后股骨坏死的相关文献。检索中文关键词为"股骨颈骨折、股骨头坏死、有限元分析、力学、应力、螺钉、植入物、血供、分子生物学、基因"。检索英文关键词为"Femoral neck fracture,femoral head necrosis,finite element analysis,mechanics,stress,screws,implants,blood supply,molecular biology,genes"。结果与结论:青壮年股骨颈骨折内固定后内固定取出与否均可导致股骨头坏死的发生。内固定取出时易造成微骨折,甚至再骨折;内固定不取出时,伴随着内固定的长期置留,内固定物周围形成大量的硬化骨,其可能是青壮年股骨颈骨折术后股骨头坏死并快速塌陷的重要力学机制之一。通过文献分析不同骨折模型及不同类型内固定物,可知倒三角结构虽然是最优治疗方式,但其仍不可避免应力的集中,导致硬化骨的形成,最终导致股骨头的坏死塌陷。因此提出在内固定周围形成硬化骨之前,适时的取钉并置入一种新型高强度、可降解、多微孔结构及又可促进成骨血管化的内置物,避免应力集中在内固定周围,用以抑制硬化骨的形成,从而可终止股骨头坏死的发生。

BACKGROUND:The prevention of femoral head necrosis after femoral neck internal fixation in young adults is still a challenge in the field of orthopedics.The pathogenesis of femoral head necrosis after internal fixation of femoral neck fractures in young adults is still a topic of discussion.OBJECTIVE:To review the pathogenesis of femoral head necrosis after internal fixation of femoral neck fractures in young adults.METHODS:PubMed,EMbase,Wanfang database,VIP and CNKI were retrieved for related articles on femoral necrosis after internal fixation of femoral neck fractures in young and middle-aged people published from 2010 to 2021 by computer.The keywords were"femoral neck fracture,femoral head necrosis,finite element analysis,mechanics,stress,screws,implants,blood supply,molecular biology,genes"in Chinese and English.RESULTS AND CONCLUSION:After internal fixation of femoral neck fractures in young adults,whether the internal fixation is removed or not can lead to the occurrence of femoral head necrosis.When the internal fixation is taken out,it is easy to cause micro fractures or even fractures again.When the internal fixation is not removed,with the long-term retention of the internal fixation,a large amount of sclerotic bone is formed around the internal fixation,which may be one of the important mechanical mechanisms of femoral head necrosis and rapid collapse after femoral neck fracture in young adults.Through literature analysis of different fracture models and different types of internal fixation,it can be seen that although the inverted triangle structure is the best treatment method,it is still inevitable that the stress concentration will lead to the formation of sclerotic bone,and ultimately lead to the necrosis and collapse of the femoral head.Therefore,we propose to take the nails at the right time before the formation of hardened bone around the internal fixation,and insert a new type of high-strength,degradable,microporous structure,and promote osteogenesis and vascularization,to avoid stress concentration.Internal fixation is used to inhibit the formation of sclerotic bone,which can stop the occurrence of femoral head necrosis.