Orthopedic Surgery and Traumatology Department, Hautepierre Hospital, Strasbourg University Hospitals, 1, avenue Molière, 67098 Strasbourg cedex, France.
Orthop Traumatol Surg Res. 2011 Feb;97(1):79-88. doi: 10.1016/j.otsr.2010.06.014. Epub 2010 Nov 18.
Femoral neck fracture puts at risk functional prognosis in young patients and can be life-threatening in the elderly. The present study reviews methods of femoral head vascularity assessment following neck fracture, to address the following issues: what is the risk of osteonecrosis? And what, in the light of this risk, is the best-adapted treatment to avoid iterative surgery? Femoral head vascularity depends on retinacular vessels and especially the lateral epiphyseal artery, which contributes from 70 to 80% of the femoral head vascular supply. Fracture causes vascular lesions, which are in turn the prime cause of necrosis. Other factors combine with this: hematoma tamponade effect, reduced joint space and increased pressure due to lower extremity positioning in extension/internal rotation/abduction during surgery. Head deformity is not due to direct cell death but to the repair process originating from the surrounding living bone. In post-traumatic necrosis, proliferation rapidly invades the head, with significant osteogenesis. Pathologic fractures occur at the boundary between the new and dead bone. Many techniques have been reported to help assess residual hemodynamics and risk of necrosis. Some are invasive: superselective angiography, intra-osseous oxygen pressure measurement, or Doppler-laser hemodynamic measurement; others involve imaging: scintigraphy, conventionnal or dynamic MRI. The future seems to lie with dynamic MRI, which allows a new classification of femoral neck fractures, based on a non-invasive assessment of femoral head vascularity.
股骨颈骨折使年轻患者的功能预后面临风险，而在老年人中则可能危及生命。本研究回顾了颈骨折后股骨头血运评估的方法，以解决以下问题：骨坏死的风险有多大？根据这种风险，哪种治疗方法最适合避免反复手术？股骨头的血供依赖于关节囊的血管，特别是外侧骺外侧动脉，它提供了股骨头血供的 70%到 80%。骨折会导致血管损伤，而这正是坏死的主要原因。其他因素也会与之结合：血肿填塞效应、关节间隙减少以及下肢在手术中伸直内收外展位时增加的压力。头部变形不是由于直接的细胞死亡，而是由于来自周围活骨的修复过程。在创伤后坏死中，增生迅速侵犯头部，导致大量成骨。病理性骨折发生在新旧骨交界处。已经报道了许多技术来帮助评估残余血液动力学和坏死风险。有些是侵入性的：超选择性血管造影、骨内氧压测量或多普勒激光血液动力学测量；还有一些涉及成像：闪烁扫描、常规或动态 MRI。未来似乎在于动态 MRI，它可以基于对股骨头血运的非侵入性评估，对股骨颈骨折进行新的分类。
