Frihagen F, Madsen J E, Reinholt F P, Nordsletten L
Orthopaedic Centre, Ullevål University Hospital, Faculty of Medicine, University of Oslo, 0407 Oslo, Norway.
Injury. 2007 Jul;38(7):797-805. doi: 10.1016/j.injury.2007.03.005. Epub 2007 Jun 4.
We wanted to assess a new technique for augmentation of parallel screws in internal fixation of displaced femoral neck fractures with a bis-GMA-based composite delivered around the screw head. Twenty-one consecutive patients admitted with displaced femoral neck fractures were operated with internal fixation with two parallel Olmed screws augmented with the composite, and followed for 24 months. The composite was introduced through the lumen of the cannulated screws and deposited in the femoral head around the threaded part of the screws. The procedure of augmenting was technically feasible and operation time was on average 33 min. Eleven patients were re-operated due to healing complications within 24 months. There were five redisplacements, four non-unions and two cases of avascular necrosis. Histological examination of four extracted femoral heads showed fragmentation of the composite into small particles with foreign-body response with giant cells and macrophages along with granulation tissue formation and low grade inflammation. The method of augmentation was technically easy, but the failure rate was high and the fragmentation of the composite with inflammatory response found on histology is noteworthy.
我们想要评估一种新技术，即在使用基于双甲基丙烯酸缩水甘油酯（bis-GMA）的复合材料围绕螺钉头部进行移位型股骨颈骨折内固定时增强平行螺钉的效果。连续21例因移位型股骨颈骨折入院的患者接受了使用两枚平行的奥尔梅德（Olmed）螺钉并辅以该复合材料进行内固定的手术，并随访24个月。该复合材料通过空心螺钉的管腔引入，并沉积在股骨头内螺钉螺纹部分周围。增强操作在技术上是可行的，平均手术时间为33分钟。11例患者在24个月内因愈合并发症接受了再次手术。有5例再移位、4例骨不连和2例缺血性坏死。对4个取出的股骨头进行组织学检查显示，复合材料破碎成小颗粒，伴有异物反应，有巨细胞和巨噬细胞，同时伴有肉芽组织形成和轻度炎症。增强方法在技术上很简单，但失败率很高，并且组织学上发现的复合材料破碎及炎症反应值得关注。
