Vicario C, Marco F, Ortega L, Alcobendas M, Dominguez I, López-Durán L
Department of Traumatology and Orthopaedic Surgery, Hospital Clínico San Carlos, Madrid, Spain.
Injury. 2003 Feb;34(2):129-34. doi: 10.1016/s0020-1383(02)00171-7.
Cut-out of the lag screw after fixation of trochanteric fractures with intramedullary devices like the Gamma Locking Nail is a well documented cause of late mechanical failure. Avascular necrosis of the femoral head after trochanteric fractures is an uncommon complication and several causes have been described. As far as we know, the relation of the mechanical failure of fracture fixation and avascular necrosis of the femoral head in trochanteric fractures has never been described. We present a study of six consecutive patients who underwent arthroplasty after cut-out of the lag screw fixation of a trochanteric fracture with Gamma Locking Nail. All six femoral heads were studied histologically and a clinical retrospective study was also performed. In all cases, we found homogeneous avascular necrosis of the femoral head; in all but one, revascularisation was present in every area examined. We suggest that after fixation of these trochanteric fractures with the Gamma Locking Nail, there is a transitory ischaemia, if the revascularisation is not enough to provide a strong support for the lag screw, it may result in late mechanical failure in these fractures.
使用髓内装置（如伽马锁定钉）固定转子间骨折后取出拉力螺钉是导致晚期机械性失效的一个已被充分记录的原因。转子间骨折后股骨头缺血性坏死是一种罕见的并发症，已有多种原因被描述。据我们所知，转子间骨折中骨折固定的机械性失效与股骨头缺血性坏死之间的关系从未被描述过。我们报告了一项对6例连续患者的研究，这些患者在使用伽马锁定钉固定转子间骨折后拉力螺钉取出后接受了关节置换术。对所有6个股骨头进行了组织学研究，并进行了临床回顾性研究。在所有病例中，我们发现股骨头均为均匀性缺血性坏死；除1例以外，在所检查的每个区域均有血管再生。我们认为，使用伽马锁定钉固定这些转子间骨折后，会出现短暂性缺血，如果血管再生不足以对拉力螺钉提供有力支撑，可能会导致这些骨折的晚期机械性失效。
