股骨颈动力交叉钉系统的力学特性及临床应用进展

Mechanical properties and clinical application of femoral neck system

股骨颈骨折手术治疗的原则是解剖复位、坚强固定,同时减少医源性组织损伤,维持良好的血运,降低股骨头缺血性坏死等并发症的发生风险。在股骨颈骨折内固定结构演变的历程中出现了各种新产品,包括以动力髋螺钉为代表的颈干角稳定结构、以3枚空心螺钉为代表的多螺钉结构、以多螺钉结构结合锁定钢板为代表的板钉结构等,这些内固定物在稳定性与降低并发症发生风险方面各具优劣,但均无法完全达到该手术原则的要求。为进一步改进股骨颈骨折内固定装置,股骨颈动力交叉钉系统(FNS)于2017年首次应用于临床,近年来不少文献已报道其力学特性及临床疗效,并试图进一步改进该内固定物的置入方式。本文就FNS的力学特性及临床疗效的相关研究,结合骨科医师对其置入方式的改进建议做一综述。

The principles for surgical treatment of femoral neck fracture are anatomical reduction,rigid fixation and reduction of iatrogenic tissue damage to maintain sufficient blood supply and reduce the risk of complications such as avascular necrosis of the femoral head.In the evolution of internal fixation structures for femoral neck fracture,a variety of new products have been developed,such as the neck-shaft angle stabilization structure represented by dynamic hip screw,the multi-screw structure represented by three cannulated screws,and the plate-screw structure represented by multi-screw structure combined with a locked plate.These internal fixation structures have their own advantages and disadvantages in terms of stability and reduced risk of complications.However,none of them can perfectly meet the requirements of all the surgical principles.Femoral neck system(FNS)was firstly applied in clinic practice in 2017 to further improve the internal fixation of femoral neck fracture.In recent years,its mechanical properties and clinical effects have been widely reported in an attempt to further improve the implantation of this internal fixation device.This article reviews the researches on the mechanical properties and clinical efficacy of FNS and the suggestions put forward by orthopedic surgeons to improve the implantation methods of FNS.