Krastman Patrick, van den Bent Rob P, Krijnen Pieta, Schipper Inger B
Department of General Surgery and Traumatology, University Hospital Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands.
Arch Orthop Trauma Surg. 2006 Jul;126(5):297-303. doi: 10.1007/s00402-006-0143-4. Epub 2006 Apr 21.
Undisplaced intracapsular fractures are predominantly treated with a minimally invasive fixation technique, whereas the standard treatment for displaced intracapsular fractures is still a subject of discussion. The purpose of this study was to identify the determinants influencing the outcome of intracapsular femoral neck fractures, treated with two cannulated hip screws.
From January 1998 through December 2002 data of all consecutive patients with an intracapsular femoral fracture, treated with two cannulated screws, were documented. Consolidation was chosen as the primary endpoint, mortality and a reoperation for replacement of osteosynthesis were defined secondary endpoints.
One hundred and twelve patients were included in the study. Fifty six percent of the intracapsular fractures healed within 1 year. Consolidation was accomplished in 95% of the stable fractures. Consolidation rates were negatively influenced by unstable fractures and inadequate anatomical reduction. The position of the screws did not influence consolidation rates. Reintervention rates were related to the number of local complications and the fracture type.
In conclusion, the results of this study show that in case of operative treatment, undisplaced femoral neck fractures can be adequately fixated by two cannulated hip screws. Unstable, anatomically reduced femoral neck fracture (Garden III/IV) may be treated with a more stable implant (e.g. DHS) to avoid redisplacement. If adequate reduction cannot be achieved, endoprosthetic replacement is recommended.
无移位的囊内骨折主要采用微创固定技术治疗，而移位囊内骨折的标准治疗方法仍存在争议。本研究的目的是确定影响采用两枚空心加压螺钉治疗的股骨颈囊内骨折预后的决定因素。
记录1998年1月至2002年12月期间所有采用两枚空心螺钉治疗的股骨颈囊内骨折连续患者的数据。将骨折愈合选为主要终点，将死亡率和再次手术更换内固定定义为次要终点。
112例患者纳入本研究。56%的囊内骨折在1年内愈合。95%的稳定骨折实现了骨折愈合。不稳定骨折和解剖复位不充分对骨折愈合率有负面影响。螺钉位置不影响骨折愈合率。再次干预率与局部并发症数量和骨折类型有关。
总之，本研究结果表明，在手术治疗的情况下，无移位的股骨颈骨折可用两枚空心加压螺钉充分固定。不稳定、解剖复位的股骨颈骨折（Garden III/IV型）可用更稳定的植入物（如动力髋螺钉）治疗以避免再移位。如果无法实现充分复位，建议行人工关节置换。
