Baixauli E J, Baixauli F, Baixauli F, Lozano J A
Department of Orthopaedic Surgery, La Fe University Hospital, Valencia, Spain.
J Orthop Trauma. 1999 Feb;13(2):134-7. doi: 10.1097/00005131-199902000-00011.
To determine factors that may influence the appearance of avascular necrosis after intertrochanteric fractures.
Retrospective.
University hospital.
Twelve patients between the ages of fifty-nine and eighty-eight who had developed avascular necrosis of the femoral head after treatment of an intertrochanteric femur fracture at our institution between 1976 and 1995. Fractures were classified according to Kyle and Gustilo. There were three Type I, two Type II, six Type III, and one Type IV fractures.
Risk factors for osteonecrosis, fracture pattern, surgical influence, location of the nail within the femoral head, and valgus malalignment.
All fractures healed. Five patients had risk factors for osteonecrosis. Intertrochanteric fractures with a proximal fracture line appeared in five patients. The nail tip was situated in every quadrant of the femoral head. Valgus malalignment occurred in three cases.
Avascular necrosis of the femoral head is an uncommon complication after intertrochanteric fractures. The pathogenesis is unknown, but in patients developing pain who have had intertrochanteric fractures, osteonecrosis should be included in the differential diagnosis, especially in cases with risk factors for osteonecrosis or a proximal intertrochanteric fracture line that perhaps disrupts the vascular anastomotic ring at the base of the femoral neck.
确定可能影响转子间骨折后缺血性坏死出现的因素。
回顾性研究。
大学医院。
1976年至1995年间在我院接受股骨转子间骨折治疗后发生股骨头缺血性坏死的12例患者，年龄在59岁至88岁之间。骨折根据凯尔（Kyle）和古斯蒂洛（Gustilo）分类。有3例I型骨折、2例II型骨折、6例III型骨折和1例IV型骨折。
骨坏死的危险因素、骨折类型、手术影响、髓内钉在股骨头内的位置以及外翻畸形。
所有骨折均愈合。5例患者有骨坏死的危险因素。5例患者出现近端骨折线的转子间骨折。髓内钉尖端位于股骨头的各个象限。3例出现外翻畸形。
股骨头缺血性坏死是转子间骨折后一种不常见的并发症。其发病机制尚不清楚，但对于转子间骨折后出现疼痛的患者，应将骨坏死纳入鉴别诊断，尤其是存在骨坏死危险因素或近端转子间骨折线可能破坏股骨颈基底血管吻合环的病例。
