基于杠杆-支点平衡理论重新认识股骨近端外侧壁的作用

Re-recognition of the role of lateral wall of proximal femur based on the theory of lever-pivot balance

股骨转子间骨折早期内固定治疗有助于改善患者生活质量,降低致残、致死率。但在以往股骨转子间骨折治疗中存在头颈螺钉切出、髋内翻、退钉、股骨颈短缩、内固定断裂等问题,并缺乏合理的解释。“外侧壁”学说曾获得多数学者的认可并用于指导内固定研发和临床应用,但并未完全避免上述并发症的发生。正确认识股骨近端外侧壁的力学作用,有助于选择合理的内固定方式用于股骨转子间骨折的治疗,从而减少并发症的发生。笔者首先讨论外侧壁测量和加强固定的方法,同时根据杠杆-支点平衡理论,合理解释骨折术后出现并发症的原因,提出股骨近端仿生髓内钉系统(PFBN)是治疗股骨转子间骨折的理想选择。

Early internal fixation for intertrochanteric fracture of the femur can improve the quality of patients′life and reduce disability and mortality.In the past,treatment of intertrochanteric fracture of the femur had some problems,such as head and neck screw cut-out,hip varus deformity,nail withdrawal,femoral neck shortening,and internal fixator fracture,etc.,for which no reasonable explanation could be provided.The"lateral wall"theory has been recognized by most scholars and used to guide the development and clinical application of internal fixation,which has not entirely avoided the occurrence of the complications mentioned above.A correct understanding of the mechanics of the lateral wall of the proximal femur helps choose a reasonable internal fixation method for the treatment of intertrochanteric fracture of the femur to reduce the incidence of complications.The author firstly discusses the lateral wall measuring and fixation strengthening methods,reasonably explore the reasons for postoperative complications according to the theory of lever-pivot balance,and proposes that the proximal femoral bionic nail(PFBN)is an ideal choice for the treatment of intertrochanteric fracture of the femur.