成人股骨颈骨折内固定技术的研究进展

Research Progress of Internal Fixation Technique for Femoral Neck Fracture in Adults

股骨颈骨折是临床常见损伤,约占全身骨折总数的3.58%,由于社会人口老龄化的逐渐发展,预计到2050年全球髋部骨折患者将达到630万,由于成人股骨颈骨折多数是由于高能量损伤造成,此类骨折的断端存在较大垂直剪切力,骨折端错位程度一般较重,为不稳定型股骨颈骨折,因而常伴有局部血管的损伤,易引起骨不连、股骨头坏死及内固定的失效等问题,这些对于骨折的治疗可能相当具有挑战性。其中成人股骨颈骨折的内固定技术在许多方面一直存在争议,无论选择何种内固定方法,目标都是解剖复位和稳定内固定。近年来,计算机辅助骨科手术(computer assisted orthopaedic surgery, CAOS),也称骨科导航手术,发展十分迅速,在提高手术定位精度、减少手术损伤、实施复杂骨科手术、提高手术成功率方面的表现卓越,在股骨颈骨折治疗方面也充分体现了上述优点,虽应用时间较短,但正在被人们广泛地研究并逐渐地应用于临床,受到各国骨科医师的高度重视。本文对不同成人股骨颈骨折的内固定方法及CAOS技术在治疗股骨颈骨折方面的优势和不足等进行综述。

Femoral neck fracture is a common clinical injury, accounting for about 3.58% of the total number of systemic fractures. Due to the gradual development of aging of society and population, it is expected that the number of hip fracture patients worldwide will reach 6.3 million by 2050. As most adult femoral neck fractures are caused by high-energy injuries, there is a large vertical shear force at the broken end of such fractures. The degree of dislocation at the fracture end is generally severe, which is an unstable femoral neck fracture, and is often accompanied by local vascular injury, which is easy to cause problems such as bone nonunion, femoral head necrosis and internal fixation failure, etc., which may be quite challenging for the treatment of fracture. Among them, the internal fixation technique of femoral neck fracture in adult has been controversial in many aspects. No matter what internal fixation method is chosen, the goal is anatomic reduction and stable internal fixation. In recent years, computer assisted orthopaedic surgery (CAOS), also known as orthopaedic navigation surgery, has developed rapidly and achieved remarkable performance in improving surgical positioning accuracy, reducing surgical injury, performing complex orthopaedic surgery, and improving the success rate of surgery. The above advantages are also fully reflected in the treatment of femoral neck fracture. Although it has been applied for a short time, it is being widely studied and gradually applied in clinical practice, and is highly valued by orthopedic surgeons around the world. This article reviews the advantages and disadvantages of different methods of internal fixation for femoral neck fracture in adults and CAOS technique in the treatment of femoral neck fracture.