Karaeminogullari Oguz, Demirors Huseyin, Atabek Mesut, Tuncay Cengiz, Tandogan Reha, Ozalay Metin
Baskent University, Department of Orthopaedics and Traumatology, Ankara, Turkey.
Adv Ther. 2004 Sep-Oct;21(5):335-42. doi: 10.1007/BF02850038.
This study assessed the effect of fracture displacement and elapsed time before surgery on the development of avascular necrosis and nonunion after internal fixation of femoral neck fractures. Twenty-eight patients with 30 femoral neck fractures who underwent internal fixation and completed a minimum of 2 years' follow-up were retrospectively analyzed. The rates of avascular necrosis and nonunion were 12.5% and 25%, respectively, among patients who underwent surgery before 12 hours had elapsed and 14% and 27% among those who underwent surgery after that time. The rates of avascular necrosis and nonunion associated with fracture displacement were 6% and 18%, respectively, among patients with undisplaced (Garden stages 1 and 2) fractures and 23% and 38% among those with displaced (Garden stages 3 and 4) fractures. Nonunion and avascular necrosis led to the necessity for additional surgery in 11 of 30 (36%) hips. Internal fixation of femoral neck fractures is associated with a high initial complication rate, but if successful, the procedure ensures an excellent long-term outcome. Internal fixation should be considered the treatment of choice in young patients with nondisplaced fractures.
本研究评估了股骨颈骨折内固定术后骨折移位情况及术前等待时间对缺血性坏死和骨不连发生的影响。对28例30处股骨颈骨折行内固定术且至少随访2年的患者进行回顾性分析。在伤后12小时内行手术的患者中，缺血性坏死和骨不连发生率分别为12.5%和25%，而在此之后行手术的患者中，这两个发生率分别为14%和27%。无移位骨折（Garden 1期和2期）患者中，与骨折移位相关的缺血性坏死和骨不连发生率分别为6%和18%，而移位骨折（Garden 3期和4期）患者中这两个发生率分别为23%和38%。30个股骨头中有11个（36%）因骨不连和缺血性坏死而需要再次手术。股骨颈骨折内固定术初期并发症发生率较高，但如果手术成功，该手术可确保良好的长期疗效。对于无移位骨折的年轻患者，应考虑将内固定术作为首选治疗方法。
