Zlowodzki Michael, Jönsson Anders, Paulke Ritva, Kregor Philip J, Bhandari Mohit
Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada.
Clin Orthop Relat Res. 2007 Aug;461:213-8. doi: 10.1097/BLO.0b013e31805b7ec4.
When using parallel screws for treatment of femoral neck fractures, shortening of the femoral neck might occur. Given the high revision surgery rates associated with parallel screws, we developed a questionnaire to explore (1) surgeons' viewpoints on difficulties in the fixation of femoral neck fractures, (2) their perception of the clinical importance of femoral neck shortening after internal fixation, and (3) their opinions regarding the ideal fixation device. Two hundred three surgeons responded. Eighty-three percent believed shortening of the femoral neck is common after screw fixation of femoral neck fractures; 89% believed shortening limits hip abductor function; and 69% believed shortening limits patients' physical function. When asked for features of the ideal implant for treatment of a femoral neck fracture, allowing compression across the fracture site on insertion and providing angular stability with a fixed-angle device to minimize shortening of the femoral neck were favored by 89% and 79% of the respondents, respectively. A plate with multiple nonparallel lag screws that can be locked into the plate might be a solution. However, the findings of this study are surgeons' opinions, which may or may not be confirmed by scientific evidence.
使用平行螺钉治疗股骨颈骨折时，可能会出现股骨颈缩短的情况。鉴于与平行螺钉相关的高翻修手术率，我们设计了一份问卷，以探讨：（1）外科医生对股骨颈骨折固定困难的看法；（2）他们对内固定后股骨颈缩短临床重要性的认识；（3）他们对理想固定装置的意见。203名外科医生进行了回复。83%的人认为股骨颈骨折螺钉固定后股骨颈缩短很常见；89%的人认为缩短会限制髋外展肌功能；69%的人认为缩短会限制患者的身体功能。当被问及治疗股骨颈骨折的理想植入物的特点时，89%的受访者赞成植入物在插入时能在骨折部位实现加压，79%的受访者赞成使用角稳定固定装置以尽量减少股骨颈缩短。带有多个可锁定在钢板内的非平行拉力螺钉的钢板可能是一种解决方案。然而，本研究的结果只是外科医生的观点，可能得到科学证据的证实，也可能得不到证实。
