Bonnaire F, Lein T, Engler K-J
Klinik für Unfall-, Wiederherstellungs- und Handchirurgie, Städtisches Klinikum Dresden-Friedrichstadt, Friedrichstrasse 41, 0167, Dresden, Deutschland.
Chirurg. 2008 Jun;79(6):595-611; quiz 612. doi: 10.1007/s00104-008-1551-5.
Due to the high incidence (600-900 patients/year >65 years old), the expected increase in frequency by a factor of five by 2050, and the proportionately shrinking capacity in trauma centers, femoral neck fractures are relevant to health care both economically and politically. Surgical treatment within 6 h improves results of osteosynthesis, within 24 h reduces general complications, and within 48 h reduces mortality. The literature displays great regional differences in methods and results. There is however general agreement that the hip joint should be preserved in young, active patients, regardless of fracture type and dislocation and that endoprosthesis is desirable for elderly patients with severe dislocation. The controversies begin with compressed fracture, determination of the degree of dislocation, and age and physical condition of patients who would profit from endoprosthesis. Total endoprostheses show better results in more active patients than do hemiarthroconstructions. Cemented endoprostheses are preferable in older patients due to their better function and lower postoperative pain. The DGU recommends prophylactic osteosynthesis for impacted fracture and osteosynthesis for nondislocated fracture or when closely following slightly dislocated fracture.
由于股骨颈骨折发病率高（每年600 - 900例65岁以上患者），预计到2050年发病率将增加五倍，且创伤中心的治疗能力相应萎缩，因此股骨颈骨折在经济和政治上都与医疗保健密切相关。6小时内进行手术治疗可改善骨合成效果，24小时内进行手术可减少一般并发症，48小时内进行手术可降低死亡率。文献表明，治疗方法和结果存在很大的地区差异。然而，人们普遍认为，对于年轻、活跃的患者，无论骨折类型和脱位情况如何，都应保留髋关节；对于严重脱位的老年患者，人工关节置换是可取的。争议始于压缩性骨折、脱位程度的判定，以及适合进行人工关节置换的患者的年龄和身体状况。全髋关节置换术在活动较多的患者中比半髋关节置换术效果更好。骨水泥型人工关节置换术在老年患者中更可取，因为其功能更好，术后疼痛更低。德国骨创伤外科学会（DGU）建议对嵌插骨折进行预防性骨固定，对无脱位骨折或轻度脱位骨折密切随访时进行骨固定。
