Fontanesi G, Costa P, Giancecchi F, Tartaglia I
I Divisione Chirurgica, Istituto Ortopedico Rizzoli, Bologna.
Ital J Orthop Traumatol. 1991 Sep;17(3):293-304.
Twenty-four patients ranging from 28 to 56 years of age with Garden grade III or IV fractures of the femoral neck are reviewed after treatment by intertrocherantic valgus osteotomy and Richards sliding compression hip screw. The rationale behind this treatment, the operative technique, and the choice of internal fixation device are all discussed. All patients were followed up after more than 2 years so that any late complications could be documented. The results were evaluated using both the Merle d'Aubigné procedure and radiographic examination: 12 (50%) were rated excellent, 5 (20.8%) good, 2 (8.4%) fair, and 5 (20.8%) poor. The unsatisfactory results are analyzed in detail, attributable to non-union in 2 cases (due to technical error), avascular necrosis in 4 cases (2 were limited and well-tolerated by the patients; 2 were early and massive and necessitated prosthetic replacement), and infection in one case. Even though valgus osteotomy and internal fixation fill a gap in the treatment of femoral neck fractures in adults by yielding good results with a conservative method, they are very demanding surgical procedures, requiring anatomical reduction, atraumatic technique, precise calculation of the valgus angle, and precise placement of the internal fixation device.
回顾了24例年龄在28至56岁之间、患有Garden III级或IV级股骨颈骨折的患者，这些患者接受了转子间外翻截骨术和Richards滑动加压髋螺钉治疗。讨论了这种治疗方法背后的原理、手术技术以及内固定装置的选择。所有患者均接受了超过2年的随访，以便记录任何晚期并发症。使用Merle d'Aubigné方法和影像学检查对结果进行评估：12例（50%）评定为优秀，5例（20.8%）为良好，2例（8.4%）为一般，5例（20.8%）为差。对不满意的结果进行了详细分析，2例（由于技术失误）归因于骨不连，4例为缺血性坏死（2例有限且患者耐受性良好；2例为早期且广泛，需要进行假体置换），1例为感染。尽管外翻截骨术和内固定通过保守方法取得了良好效果，填补了成人股骨颈骨折治疗的空白，但它们是要求很高的外科手术，需要解剖复位、无创技术、精确计算外翻角度以及精确放置内固定装置。
