Estrada Lance S, Volgas David A, Stannard James P, Alonso Jorge E
Division of Orthopaedic Surgery, University of Alabama at Birmingham, 1530 3 Avenue South, Birmingham, AL 35294-3295, USA.
Clin Orthop Relat Res. 2002 Jun(399):110-8. doi: 10.1097/00003086-200206000-00013.
Fixation of femoral neck fractures is associated with a higher incidence of complications than any other fracture. The rates of nonunion and avascular necrosis with open reduction and internal fixation continue to be unacceptably high. These complications are the main reason for resorting to primary endoprosthetic replacement of the femoral head in the presence of displaced fractures in elderly patients. However, with the increasing life span of the patients with these prostheses, late complications of endoprosthetic replacement of the femoral head are becoming significant. With these complications, it may be argued that the most cost-effective solution to the femoral neck fracture in the majority of patients is open reduction and internal fixation, with elective conversion, when necessary, to total hip arthroplasty in patients who have a complication. Because the literature does not contain a systematic review of reasons for failure of internal fixation, the authors will attempt to review the common means of failure of internal fixation in young and older patients in an attempt to better understand and prevent these complications.
与其他任何骨折相比，股骨颈骨折的固定术并发症发生率更高。切开复位内固定术后的骨不连和缺血性坏死发生率仍然高得令人难以接受。在老年患者出现移位骨折时，这些并发症是采用股骨头一期人工关节置换术的主要原因。然而，随着接受这些假体植入患者寿命的延长，股骨头人工关节置换术的晚期并发症正变得日益显著。鉴于这些并发症，有人可能会认为，对大多数患者而言，最具成本效益的股骨颈骨折治疗方案是切开复位内固定术，必要时对出现并发症的患者择期改行全髋关节置换术。由于文献中没有关于内固定失败原因的系统综述，作者将尝试回顾年轻和老年患者内固定失败的常见方式，以便更好地理解并预防这些并发症。
