Spontaneous bilateral femur neck fracture secondary to grand mal seizure:A case report

BACKGROUND Spontaneous bilateral femur neck fracture is a rare entity in the general population.CASE SUMMARY A 17-year-old immobile,developmentally delayed male with the sequelae of cerebral palsy fractured both femoral necks during a grand mal epileptic seizure.He had been treated with valproic acid as an antiseizure medication for about 10years;otherwise,he had no history of drug use.The laboratory analysis was normal except a marked vitamin D deficiency.Closed reduction and osteosynthesis with percutaneous cannulated screws were performed.Solid union was observed at 6 mo,and rapid postoperative rehabilitation was started.CONCLUSION A femoral neck fracture may occur in a person with epilepsy presenting with hip pain in the emergency department.

Valgus osteotomy for nonunion and neglected neck of femur fractures

Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.

Bone mineral density in fracture neck of femur patients:What's the significance?

BACKGROUND The National Institute for Health and Care Excellence(NICE)guidelines have advised further research is required into investigating the added prognostic value of bone mineral density(BMD)in the assessment of fracture risk with the Fracture Risk Assessment Tool(FRAX)score.AIM To investigate the significance of BMD in fracture neck of femur patients and compare it to the outcome of the FRAX score.METHODS Inclusion criteria for this study were all patients who underwent dual-energy Xray absorptiometry(DXA)scan following fracture neck of femur between 2015 and 2017.Analysis of BMD,FRAX scores and patient demographic data was undertaken.RESULTS A total of 69 patients were included in the study,mean age 74.1 years.There was no significant difference between mean BMD of the femoral neck in males(0.65)as compared to females(0.61)(P=0.364).Analyses showed no significant correlation between BMD and menopause age(rs=-0.28,P=0.090).A significant difference was seen of the femoral neck BMD between the different fracture pattern types(P=0.026).A stronger correlation was observed between BMD of femoral neck and FRAX major score(rs=-0.64,P<0.001)than with BMD of lumbar spine and FRAX major score(rs=-0.37,P=0.003).CONCLUSION This study demonstrated that BMD of the femoral neck measured by DXA scan is of added prognostic value when assessing patients for risk of fracture neck of femur in combination with the FRAX predictive scoring system.

Surgical Management of Fracture Neck of Femur in a Medically Unfit ASA3/4 Patient Selection Using Direct Infiltration Local Anaesthesia

Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip fracture accounts for 87% of total fragility fractures. We describe an anaesthetic technique of fixation of fracture of the femoral neck under direct infiltration local anaesthesia;that can be performed on the sick elderly patient. Twenty-eight NOF fractures were included in this series (24 DHS, 4 Hemiarthroplasty);twenty-three procedures were completed (82.14%);no patient required conversion to another form of anaesthesia either general or spinal;five patients required some degree of light sedation due to agitation (17.8%). This method presents itself as an option in managing patient with high comorbidities which can also be implemented in impoverished areas with limited access to operating surgical facilities.

股骨颈骨折空心钉内固定后股骨近端骨质疏松的有限元分析

背景:股骨颈骨折空心钉内固定术后由于患肢短期内常常不能负重,且高刚度的内植物对骨折断端存在应力遮挡效应,易导致患肢出现骨质疏松,股骨近端生物力学分布发生变化,术后股骨头坏死发病率较高,目前关于股骨颈骨折术后股骨近端骨质疏松对股骨近端及空心钉生物力学影响的研究较少。目的:通过有限元分析探讨股骨颈骨折术后发生骨质疏松对空心钉内固定治疗的生物力学影响,探究生物力学因素在股骨头坏死进程中的作用。方法:获取1例股骨颈骨折患者股骨CT扫描数据,利用Mimics 19.0、3-Matic、UG 11.0、Hypermesh 14.0、Abaqus软件建立空心钉治疗股骨颈骨折的股骨近端模型,利用Abaqus软件分析1种术后股骨近端无骨质疏松、3种术后股骨近端骨质疏松的有限元模型,测量分析4种模型不同部件的应力、接触压力、位移峰值及云图,对比分析股骨头内部应力变化及分布情况。结果与结论:股骨头及下前空心钉的应力、接触压力随骨质疏松程度变化较大,4种模型的位移峰值随着骨质疏松程度加重而缓慢增长。通过单因素方差分析,结果显示骨质疏松程度对不同部件的应力、接触压力、位移峰值无显著性影响,股骨头内部应力分布随骨质疏松发生相应变化,股骨近端的生物力学环境变化对股骨头坏死有着重要影响。

ERAS理念联合骨科康复护理对股骨颈骨折患者髋关节置换术后疼痛及恢复情况的影响

目的探究加速康复外科(ERAS)理念联合骨科康复护理对股骨颈骨折患者髋关节置换术后疼痛及恢复情况的影响。方法选取安徽省马鞍山市中医院2019年1月至2022年3月进行治疗的股骨颈骨折患者80例,采用随机数字表法将其分为对照组和观察组,各40例。对照组给予骨科常规康复护理,观察组给予骨科常规康复护理联合ERAS理念进行干预。干预前后比较两组术后恢复情况,包括髋关节功能、髋关节置换效果、视觉模拟评分法(VAS)评分、术后情况、术后并发症发生情况。结果干预后,观察组各项髋关节功能评分均高于对照组,差异有统计学意义(P<0.05)。干预后,两组各项髋关节置换效果评分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05);两组VAS评分低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05)。干预后,观察组住院天数、术后下床活动时间短于对照组,差异有统计学意义(P<0.05);观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论ERAS理念联合骨科康复护理能够缩短股骨颈骨折患者的术后住院时间和下床所需时间,缓解术后疼痛,减少并发症,促进术后髋关节恢复。

发育性髋关节脱位患儿不同股骨颈前倾角对股骨生物力学的影响研究

目的利用计算机仿真技术模拟发育性髋关节脱位(developmental dislocation of the hip,DDH)患儿不同股骨颈前倾角时股骨的应力分布,以明确DDH患儿股骨颈前倾角矫正的意义,并指导手术方案的制定。方法回顾性分析2021年6月在山西省儿童医院骨科住院治疗的1例右侧DDH患儿影像学资料。患儿女,6岁,提取正常侧(左侧)髋关节股骨扫描数据,通过三维CT扫描重建股骨三维模型,分别设计股骨颈前倾角35°、25°、15°时的力学仿真模型,通过有限元软件进行仿真计算,观察不同股骨颈前倾角度时股骨的生物力学分布。结果DDH患儿股骨三维模型上股骨颈前倾角为35°、25°、15°时股骨模型受到的最大应力分别为21.18 MPa、17.36 MPa、9.85 MPa。股骨颈前倾角为35°时,股骨干应力集中;股骨颈前倾角为25°时,股骨远端骨骺的应力降低25%;股骨颈前倾角为15°时,股骨应力主要集中在股骨头颈至股骨干上段。股骨颈前倾角为35°时,位移大于1 mm的区间是股骨头至股骨干中段;股骨颈前倾角为25°时,位移大于1 mm的区间是股骨头至股骨干中上端;股骨颈前倾角为15°时,位移大于1 mm的区间是股骨头至股骨颈。股骨颈前倾角为35°、25°、15°时其股骨远端骨骺的最大位移分别为0.0041 mm、0.0018 mm、0.0012 mm。结论股骨颈前倾角对DDH患儿的股骨力学有着重要影响。股骨的应力分布随着股骨颈前倾角改变而改变,股骨颈前倾角度增大,股骨干应力逐渐增加,在股骨干位置出现应力集中现象;股骨颈前倾角越大,应力传递在股骨干区域受到的遮挡效应越大,股骨远端骨骺在横断面的变形也增加。股骨颈前倾角为15°时股骨应力分布较为理想。

三种手术入路全髋关节置换治疗股骨颈骨折早期临床疗效比较

目的比较直接上方入路(direct superior approach,DSA)、直接前方入路(direct anterior approach,DAA)和后外侧入路(posterolateral approach,PLA)行全髋关节置换术(total hip arthroplasty,THA)治疗股骨颈骨折(femoral neck fracture,FNF)的早期临床疗效。方法采用前瞻性随机对照研究。选择2019年7月~2021年7月收治的90例FNF患者,依据随机数字表法分为DSA组、DAA组和PLA组,每组30例,分别经DSA、DAA和PLA入路行THA。比较三组患者的手术时间、失血量、切口长度、术后下地时间及住院时间,术前、术后1周、术后1、3、6个月的髋关节Harris评分,疼痛视觉模拟评分(visual analogue scale,VAS),SF-36评分及并发症;利用影像学资料对假体安放位置、双下肢长度、髋臼前倾角、髋臼外展角及股骨柄内外翻发生率进行测量并比较。结果与DSA组和DAA组比较,PLA组手术时间更短(P=0.000)。但失血量、切口长度、术后下地时间、住院时间长、手术后1周内VAS评分、Harris评分、SF-36评分,DSA组和DAA组均优于PLA组(P=<0.05)。术后1月、3月、6月VAS评分、Harris评分、SF-36评分,三组无显著差异(P>0.05)。DAA组股骨柄内翻发生率16.7%(5/30),DSA组和PLA组无股骨柄内翻病例,DAA组高于其他两组(P<0.05)。结论相较于PLA入路,DSA入路和DAA入路具有手术创伤小、术中失血量少、术后康复快等早期优势。但是DAA入路股骨柄内翻发生率更高。

内固定治疗成人股骨颈骨折的研究进展

股骨颈骨折占成年人骨折3.85%[1],是一种常见的骨折,可发生于各个年龄段。股骨颈骨折术后骨不连和股骨头缺血性坏死一直是创伤骨科治疗的难点[2]。近年来,股骨颈骨折术后发生股骨颈短缩的并发症,引起了大家的重视和思考,股骨颈的过度短缩,可影响下肢步态,甚至导致髋关节活动障碍[3,4]。目前对股骨颈骨折的保髋治疗仍然存在较大的争议[5~7],包括内固定物选择、闭合还是切开复位、术前是否应该进行牵引等。尤其对于不稳定的Pauwels III型股骨颈骨折,需选择抗剪切力较好的内固定方式。近10年来国内外市场上涌现出不同的股骨颈骨折内固定器械,足以说明股骨颈骨折内固定物仍然不够完善。

甲状腺疾病对绝经后女性骨量丢失的影响

目的探讨甲状腺疾病对自然绝经女性骨密度的影响。方法通过回顾性病例对照研究,选取甲状腺疾病(包括甲状腺功能亢进、减退、结节、瘤和癌)患者144例,按同年龄和体质量指数(BMI)匹配288例无甲状腺疾病者。运用SPSS 24.0进行统计分析。结果甲状腺疾病组和无甲状腺疾病组比较,年龄、绝经年龄、身高、体质量和BMI差异无统计学意义,初潮年龄、怀孕次数、哺乳次数差异存在统计学意义(P<0.01)。②甲状腺疾病组股骨颈、大转子和Ward区骨密度均显著低于无甲状腺疾病组(P<0.05或P<0.01),两组腰椎骨密度比较无差异。甲状腺疾病组的骨质疏松症患病率49.31%,显著高于无甲状腺疾病组39.24%(P<0.05),甲状腺疾病组的骨折发生率21.53%高于无甲状腺疾病组16.67%,但比较差异无统计学意义。③在甲状腺疾病类分组中,甲状腺结节组较其他甲状腺疾病组股骨颈骨密度低,甲状腺结节组显著低于甲亢组和甲状腺瘤组(P<0.05)。结论患有甲状腺疾病的绝经后女性具有股骨颈低骨密度的风险,而甲状腺结节患者较甲亢和甲状腺瘤患者股骨颈低骨密度风险更大。

Radiation Exposure during Dynamic Hip Screw Fixation: A Comparative Study

Background: The safe amount of radiation permissible during fixation of neck of femur fractures has long been studied. Factors including surgeons’ experience have been highlighted. We aimed in this study to compare different factors for quality and safety improvement. Methods: It was a retrospective study, including all patients who had undergone a standard DHS fixation between January 2018 and June 2019 for inter-trochanteric neck of femur fractures. Two groups were stratified;(Group A) had the procedure performed by a specialist non-consultant surgeon (NCG) and (Group B) by an established consultant (CG). The Dose Area Product (DAP) and the duration of radiation exposure were recorded. Results: Over a period of 18 months, 91 cases were included with a mean age of 82 years old. The mean weight was 62 kg. 42 patients had complex fractures, and 49 patients had simple fractures. 12% of patients were ASA II, 70% of cases were ASA III and 18% of the patients were ASA IV. The mean DAP for group A was 345.131 CGYCM2 (SD 273.65) and for group B 234.63 CGYCM2 (SD 165.30). The time of exposure was 8.6 sec and 13.16 sec in groups B and A respectively. Conclusion: The data collected from this study were comparable to others. The amount of radiation exposure was of difference related to the decision-making intra-operatively. Other factors were not statistically significant.

股骨近端外翻截骨植骨术治疗儿童股骨颈骨折骨不连的疗效探讨

目的评估股骨近端外翻截骨植骨术治疗儿童股骨颈骨折骨不连的疗效。方法回顾性分析2011年1月至2022年1月复旦大学附属儿科医院骨科收治的8例股骨颈骨折骨不连患儿临床资料,均采用股骨近端外翻截骨、髋加压锁定钢板固定,并对骨不连区域行植骨治疗,观察股骨髋内翻改善情况、骨不连愈合以及手术后并发症情况。结果8例股骨颈骨折骨不连患儿行股骨近端外翻截骨植骨术后均痊愈,随访时间(14.5±3.9)个月,愈合时间为(9.5±2.1)个月。术后1年随访时股骨颈干角为(145.6±9.8)°,较手术前股骨颈干角(117.6±17.0)°增加,股骨颈干角异常得到纠正,差异有统计学意义(t=4.310,P<0.05),术后发生伤口感染1例,经抗生素对症治疗3周后痊愈。结论股骨近端外翻截骨植骨术治疗儿童股骨颈骨折骨不连疗效确切,可有效纠正股骨髋内翻畸形。

加速康复外科联合舒适护理对老年股骨颈骨折患者的影响

目的分析加速康复外科(enhanced recovery after surgery,ERAS)联合舒适护理对老年股骨颈骨折(femoral neck fracture,FNF)患者的影响。方法选取开封市人民医院2020年8月至2022年8月收治的82例老年股骨颈骨折患者为研究对象,分为对照组和研究组,每组41例。对照组行常规护理,研究组行ERAS联合舒适护理,比较两组的心理状态、髋关节功能、疼痛程度、并发症及生活质量。结果护理后,研究组焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)评分均低于对照组(P<0.001);研究组护理后1个月、3个月及6个月Harris评分较对照组高(P<0.001);研究组术后1 d、3 d、5 d及7 d视觉模拟评分法(visual analogue scale,VAS)评分较对照组低(P<0.05);研究组并发症发生率较对照组低(4.88%vs.24.39%,P=0.012);研究组社会功能、心理功能、躯体功能及物质生活评分均较对照组高(P<0.001)。结论老年FNF患者应用ERAS联合舒适护理,有利于减少并发症,提高生活质量,减轻术后疼痛,并促进髋关节功能恢复,改善心理状态。

围术期快速康复护理模式对老年股骨颈骨折术后谵妄及睡眠质量的影响

目的:探讨围术期快速康复护理模式对老年股骨颈骨折术后谵妄及睡眠质量的影响。方法:选取2020年1月至2021年12月福建省三明市清流县总医院外二科收治的老年股骨颈骨折患者80例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组40例。对照组接受常规护理,观察组接受围术期快速康复护理模式干预,比较2组患者术后谵妄发生率、髋关节功能、睡眠质量等。结果:观察组术后谵妄发生率2.50%低于对照组20.00%(P<0.05);2组术前Harris髋关节功能评分比较无统计学意义(P>0.05),观察组术后1个月、3个月、6个月时Harris髋关节评分高于对照组(均P<0.05);2组术前匹兹堡睡眠质量指数(PSQI)评分比较无统计学意义(P>0.05),观察组术后12 h、24 h、48 h、72 h时PSQI评分低于对照组(均P<0.05)。结论:老年股骨颈骨折患者围术期接受快速康复护理模式干预,可降低术后谵妄发生概率,保证其拥有良好的睡眠质量,更利于髋关节功能恢复。

人工股骨头置换术与人工全髋关节置换术治疗老年股骨颈骨折的临床效果分析

目的探究对老年股骨颈骨折患者应用人工股骨头置换术与人工全髋关节置换术的效果。方法回顾性选取2017年1月—2022年5月高邮市中医医院收治的238例股骨颈骨折患者的临床资料,依据治疗方案不同分为对照组(n=132)和观察组(n=106)。对照组实施人工股骨头置换术治疗,观察组实施人工全髋关节置换术治疗,比较两组治疗效果、临床相关指标、髋关节功能评分(Harris Hip Score,HHS)、髋关节疼痛程度评分(Visual Analogue Scale,VAS)、并发症。结果观察组治疗效果(96.23%)高于对照组(89.39%),差异有统计学意义(χ^(2)=3.926,P<0.05)。与对照组相比,观察组手术时间、住院时间较长,术中出血量、术后引流量较多,差异有统计学意义(P<0.05)。术后1年,观察组HHS评分高于对照组,差异有统计学意义(P<0.05)。和对照组比较,观察组各时间点VAS评分以及并发症发生率均较低,差异有统计学意义(P<0.05)。结论采用人工股骨头置换术治疗老年股骨颈骨折患者,有着手术时间短等优点,但其远期效果较差。虽然人工全髋关节置换术的手术时间等较长,但远期效果较好,疼痛感低,并发症少,可依据患者实际情况而选择手术方案。

股骨颈皮质碎片面积和移位距离与中青年股骨颈骨折空心螺钉内固定术后并发症的关系研究

目的:探讨股骨颈皮质碎片面积和移位距离与中青年股骨颈骨折空心螺钉内固定术后并发症的关系。方法:分析2009年1月至2021年1月采用空心螺钉内固定术治疗的合并股骨颈皮质粉碎的中青年股骨颈骨折患者的病例资料,统计患者股骨头坏死和骨折不愈合的发生情况,并基于术前CT测定患者的股骨颈皮质碎片面积和移位距离。股骨颈皮质碎片面积≤0.25cm^(2)、移位距离≤0.5cm者纳入A组,皮质碎片面积≤0.25cm^(2)、移位距离>0.5cm者纳入B组,皮质碎片面积>0.25cm^(2)、移位距离≤0.5cm者纳入C组,皮质碎片面积>0.25cm^(2)、移位距离>0.5cm者纳入D组。分析股骨颈皮质碎片面积和移位距离与股骨头坏死和骨折不愈合发生率的关系。结果:共纳入348例患者,A组160例、B组71例、C组82例、D组35例。34例患者发生股骨头坏死,其中A组6例、B组9例、C组9例、D组10例;25例患者发生骨折不愈合,A组3例、B组6例、C组7例、D组9例。A组股骨头坏死发生率为3.8%[95%CI(1.3%,8.0%)]、骨折不愈合发生率为1.9%[95%CI(0.4%,5.4%)],B组股骨头坏死发生率为12.7%[95%CI(6.0%,22.7%)]、骨折不愈合发生率为8.5%[95%CI(3.2%,17.5%)],C组股骨头坏死发生率为11.0%[95%CI(5.1%,19.8%)]、骨折不愈合发生率为8.5%[95%CI(3.5%,16.8%)],D组股骨头坏死发生率为28.6%[95%CI(14.6%,46.3%)]、骨折不愈合发生率为25.7%[95%CI(12.4%,43.3%)]。结论:中青年股骨颈骨折患者的股骨颈皮质碎片面积>0.25cm^(2)且移位距离>0.5cm时,采用空心螺钉内固定术治疗后股骨头坏死和骨折不愈合的发生率明显增高。

精确定位防旋髓内钉置入治疗股骨转子间骨折

背景:闭合复位股骨近端防旋髓内钉内固定渐渐成为治疗股骨转子间骨折的金标准。目的:通过与标准切口对比,评价精确定位法改良小切口使用股骨近端防旋髓内钉置入治疗股骨转子间骨折的优势。方法:股骨转子间骨折接受闭合复位股骨近端防旋髓内钉置入内固定治疗的患者99例,其中采用改良后小切口方法的患者41例,采用标准切口的58例。对比两组患者的切口长度、内固定中出血量、平均住院时间及内固定后Harris评分。结果与结论:采用改良切口组患者内固定中出血量较标准切口组少50.9%,切口长度短44%,平均置入内固定时间明显短于标准切口组(P<0.05),两组患者平均住院时间及随访末期Harris评分值差异无显著性意义。说明使用股骨近端防旋髓内钉治疗股骨转子间骨折的病例,采用改良小切口具有切口更小,创伤更小,操作时间短及出血量少的优点。

鲑鱼降钙素对老年股骨颈骨折患者骨代谢的影响

目的探讨皮下注射鲑鱼降钙素对老年骨质疏松股骨颈骨折患者短期血液骨代谢生化指标的影响,为其提高疗效提供依据。方法选取120例股骨颈骨折患者,随机分为实验组(n=60):皮下注射鲑鱼降钙素治疗组,对照组(n=60):皮下注射生理盐水空白对照组,比较两组患者手术前,手术后1、3、7d血清钙、磷浓度和碱性磷酸酶(ALP)活性的变化情况。结果血液生化指标检查可见术后3、7d,实验组患者血清总钙、磷浓度及ALP活性均发生变化,其中实验组患者血清钙下降明显(P<0.05,P<0.01),且超出正常范围。血清磷术后7d显著低于对照组。ALP两组比较及术前、术后比较均差异不显著。结论短期应用皮下注射鲑鱼降钙素可对血清骨代谢标记物产生显著影响,其中血清钙受影响最大,血清总钙水平显著低于正常生理范围,临床应用过程中应引起重视并给予预防。

股骨颈骨折空心钉内固定数字化模板的建立

背景:按照骨折治疗的AO原则,目前治疗股骨颈骨折的趋势是尽早切开关节囊,清除血肿,解剖复位,加强内固定,不必缝合关节囊,可降低股骨头缺血性坏死的发生率。股骨颈骨折空心钉的安放位置是维持稳定构型的关键,但置钉准确性受个体差异,置钉定位影像设备二维性及术者经验等主观因素影响较大,临床上急需一种实用性强花费较小且易于推广使用的辅助置钉方法。目的:构建骨颈骨折中空加压螺钉立体模型,通过3D生物打印技术精确建立导航模板并验证。方法:18例志愿者知情同意后,连续螺旋CT进行双侧股骨上端加密扫描。将Dicom数据导入Amira3.1(TGS)软件,三维重建骨折模型,导入Image-ware12.1软件,数字化设计最佳穿刺通道,三维重建股骨颈螺钉三维立体模型。提取解剖学形态,建立反向模板,3D生物打印实物模板,进行手术模拟验证。结果与结论:成功地建立了股骨颈三维模型及空心钉内固定模型,设计出了数字通道及螺钉最佳穿刺途径,制作出导航模板。模拟手术中置钉位置全部在最佳钉位。生成的三维模型与导航模板体外贴附良好,成功穿刺后断层证明穿刺通道位置较准确。提示成功构建了数字仿真股骨颈骨折内固定三维模型,逆向工程及3D生物打印导航模板技术能够提高手术操作精确性,为临床提供理论依据和技术支持。

股骨颈骨折:问题及对策

背景:股骨颈骨折是一种临床上常见的创伤,其死亡率和病残率较高,骨折不愈合和股骨头缺血坏死是其临床治疗中存在的两个主要问题。至今,它的治疗及结果等许多方面仍遗留有许多尚未解决的问题。目的:回顾总结了股骨颈骨折的两种主要并发症发生及防治的研究进展,有助于更好地认识这种损伤并发症发生的机制,对正确选择治疗方法有指导意义。方法:总结并归纳了发表于国内外核心期刊上的关于股骨颈骨折的研究文献。对于有关多发伤或与股骨颈骨折无直接相关的研究文献则不予参考,另外,特别关注股骨颈骨折并发骨折不愈合和股骨头缺血坏死的文献。结果与结论:共检索到241篇文献,对资料进行分析,根据上述筛选标准,并以近5-10年文献为主,排除182篇内容与课题目的不符的文献,纳入59篇。通过对文献的复习可知,股骨颈骨折的发病率高,治疗方法多样,但是,其治疗效果受患者的年龄、骨折类型、骨质情况、伴发疾病等多种因素影响,迄今为止在治疗方法的选择上尚无统一的意见,选择最佳治疗方法并不能只根据骨折的影像学表现和患者的年龄,临床医师必须对影响患者骨折愈合的危险因素进行综合评价,然后再决定采用哪种治疗方法更合适,否则很容易导致治疗失败或引起并发症,增加患者精神上和经济上的负担。因此,股骨颈骨折不仅是一个医学问题,还是一个巨大的社会经济问题,找到一种经济、有效的治疗方法是所有骨科医生所面临的挑战,而骨折内固定加上骨诱导材料的应用可能为进一步提高股骨颈骨折治疗效果指出了新的方向。