Shah Asit K, Eissler Jesse, Radomisli Timothy
Leni and Peter W. May Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 East 98th Street Box 1188, New York, NY 10128, USA.
Clin Orthop Relat Res. 2002 Jun(399):28-34. doi: 10.1097/00003086-200206000-00005.
Worldwide prevalence of femoral neck fractures is increasing, doubling for patients older than 50 years. Age of the patient, prefracture activity level, and associated comorbidities must be considered when determining treatment. It seems that hemiarthroplasty is best suited for an elderly patient who is a household ambulator with low demands on the prosthesis. Younger patients, and those with minimally displaced fractures, should be treated with internal fixation in an attempt to preserve the natural hip. Proximal femur fractures in the pediatric population are associated with high complication rates. Because of vascular vulnerability, avascular necrosis of the femoral head continues to be the most frequent and serious complication after hip trauma in children. Femoral neck fractures in children also differ from those in adults because a child can tolerate immobilization much more readily than can an adult. As healthcare resources become more limited and their use becomes scrutinized more closely, cost-effective treatment algorithms for femoral neck fractures will dictate orthopaedic treatment. For some fractures, closed treatment is evolving toward interventional approaches to minimize late sequelae. With the availability of viable treatment options, the potential risks and benefits of individual treatment modalities as related to each fracture pattern must be reviewed.
全球范围内股骨颈骨折的患病率正在上升，50岁以上患者的患病率翻了一番。在确定治疗方案时，必须考虑患者的年龄、骨折前的活动水平以及相关的合并症。半髋关节置换术似乎最适合那些对假体要求不高的居家活动的老年患者。年轻患者以及骨折移位最小的患者，应采用内固定治疗，以试图保留天然髋关节。儿童人群中的股骨近端骨折并发症发生率很高。由于血管易受损，股骨头缺血性坏死仍然是儿童髋部创伤后最常见和最严重的并发症。儿童股骨颈骨折也与成人不同，因为儿童比成人更能耐受固定。随着医疗资源变得更加有限，其使用受到更严格的审查，股骨颈骨折的成本效益治疗方案将决定骨科治疗。对于一些骨折，闭合治疗正在向介入方法发展，以尽量减少晚期后遗症。随着可行治疗方案的出现，必须审查与每种骨折类型相关的个体治疗方式的潜在风险和益处。
