利用生物力学改进囊内股骨颈骨折内固定手术技术。

Using biomechanics to improve the surgical technique for internal fixation of intracapsular femoral neck fractures.

作者信息

Wu Chi-Chuan

机构信息

Department of Orthopedics, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.

出版信息

Chang Gung Med J. 2010 May-Jun;33(3):241-51.

DOI:
Abstract

Despite advances in science and technology, the success rate for the treatment of displaced intracapsular femoral neck fractures in high-energy injuries remains disappointing. The blood supply system in the femoral head of humans does not favor recovery from these fractures. Once these fractures occur, osteonecrosis and nonunion rates may be as high as 30%, even if the newest technique is used. There are some surgical techniques used to supplement internal fixation to reestablish the blood supply in the femoral head, but none have been evidently successful. After analysis of related studies, the author concludes that immediate surgical treatment using improved techniques incorporating the principles of biomechanics can improve the success rate of treatment of these fractures. Using these principles, the fracture site can achieve sufficient stability. Consequently, the blood supply in the femoral head and neck can be reestablished earlier and loss of reduction of fragments during treatment can be minimized. Thus, the chance of full recovery from these complicated fractures can be maximized. In this study, the biomechanical characteristics of these fractures and the principles associated with the surgical techniques used for treating them are reviewed and clarified. Finally, a surgical technique which is ideal from the author's viewpoint is presented. The author believes that the recommended surgical technique may become the best method for treating these complicated fractures.

摘要

尽管科学技术取得了进步,但高能损伤导致的移位型股骨颈囊内骨折的治疗成功率仍然令人失望。人类股骨头的血液供应系统不利于这些骨折的恢复。一旦发生这些骨折,即使采用最新技术,骨坏死和不愈合率可能高达30%。有一些手术技术用于辅助内固定以重建股骨头的血液供应,但均未取得明显成功。在分析相关研究后,作者得出结论,采用结合生物力学原理的改良技术进行即刻手术治疗可提高这些骨折的治疗成功率。运用这些原理,骨折部位可获得足够的稳定性。因此,股骨头和颈部的血液供应可更早重建,且治疗过程中骨折碎片的复位丢失可降至最低。这样,这些复杂骨折完全恢复的机会可最大化。在本研究中,对这些骨折的生物力学特征以及用于治疗它们的手术技术相关原理进行了回顾和阐明。最后,提出了一种作者认为理想的手术技术。作者认为所推荐的手术技术可能成为治疗这些复杂骨折的最佳方法。

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