Anglen Jeffrey O, Baumgaertner Michael R, Smith Wade R, Tornetta Iii Paul, Ziran Bruce H
Department of Orthopaedics, Indiana University, Indianapolis, Indiana, USA.
Instr Course Lect. 2008;57:17-24.
Hip fracture is an increasingly common and clinically significant injury with substantial economic impact. Associated risk factors are age, gender, race, bone density, activity level, and medical disorders. Prevention efforts include treatment of osteoporosis and programs to reduce the risks of a fall. Nondisplaced or impacted fractures of the femoral neck can be treated with screw fixation. Displaced femoral neck fractures in younger, more active patients may be treated with reduction and fixation. In physiologically older patients, joint arthroplasty is indicated for displaced fractures. In patients with systemic arthritis or preexisting hip disease, total hip arthroplasty may be an appropriate treatment choice. Intertrochanteric fractures are treated with reduction and fixation using either a sliding hip screw and side plate or intramedullary nail with cephalic interlock. Key technical points for successful outcomes include proper patient positioning, using a correct starting point for the nail, achieving acceptable reduction before fixation, and the use of various reduction techniques and aids.
髋部骨折是一种日益常见且具有临床重要意义的损伤，会产生重大经济影响。相关风险因素包括年龄、性别、种族、骨密度、活动水平和疾病。预防措施包括骨质疏松症的治疗以及降低跌倒风险的项目。无移位或嵌插型股骨颈骨折可用螺钉固定治疗。年轻、活动较多患者的移位型股骨颈骨折可进行复位和固定治疗。对于生理年龄较大的患者，移位骨折需行关节置换术。对于患有全身性关节炎或既往有髋部疾病的患者，全髋关节置换术可能是合适的治疗选择。粗隆间骨折采用滑动髋螺钉和侧板或带头颈交锁的髓内钉进行复位和固定治疗。成功治疗的关键技术要点包括患者体位正确、髓内钉起始点正确、固定前达到可接受的复位以及使用各种复位技术和辅助工具。
