Department of Orthopaedics, P D Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, India.
Arch Orthop Trauma Surg. 2012 Jan;132(1):73-9. doi: 10.1007/s00402-011-1395-1. Epub 2011 Sep 18.
Osteosynthesis in fracture neck of femur (NOF) in young is a universally acceptable procedure. Various factors affect the outcome; with AVN (avascular necrosis) and non-union primarily contributing to adverse results in such patients. To identify factors affecting outcome of displaced fracture NOF, a prospective cohort study was carried out in the setting of a tertiary care centre in developing country.
27 consecutive patients with displaced fracture NOF suitable for osteosynthesis underwent closed reduction and fixation with three 6.5 mm cancellous cannulated screws. A record of posterior comminution and its extent (as seen on CT scan) and the intracapsular pressure difference between the fractured and the opposite side was kept in all the patients. The patients were followed-up for 1 year. The main outcomes measured at 1 year were non-union (as identified by CT scan) and AVN (as identified by bone scan).
Cases with pressure difference >30 mm were found to have a higher rate of AVN and this result was found to be statistically significant (p value 0.034). The patients with significant posterior comminution were found to have higher non-union rates and this result was also found to be statistically significant (p value 0.04).
Prognosis of displaced fracture NOF is significantly associated significant with posterior comminution and intracapsular pressure difference between fractured and normal side.
在年轻患者中，股骨颈骨折（NOF）的内固定治疗是一种普遍接受的方法。各种因素都会影响治疗结果，其中主要是股骨头缺血性坏死（AVN）和骨折不愈合。为了确定影响移位性股骨颈骨折治疗结果的因素，我们在发展中国家的一家三级医疗中心进行了一项前瞻性队列研究。
对 27 例适合内固定治疗的移位性股骨颈骨折患者进行闭合复位和三根 6.5mm 空心加压螺钉固定。所有患者均记录了后柱粉碎程度及其范围（CT 扫描所见），以及骨折侧与对侧关节囊内压力差。所有患者均随访 1 年。主要观察指标为 1 年后的骨折不愈合（通过 CT 扫描确定）和股骨头缺血性坏死（通过骨扫描确定）。
发现压力差>30mmHg 的病例发生 AVN 的比例较高，且该结果具有统计学意义（p 值=0.034）。发现严重后柱粉碎的患者发生骨折不愈合的比例较高，且该结果也具有统计学意义（p 值=0.04）。
移位性股骨颈骨折的预后与后柱粉碎程度和骨折侧与正常侧关节囊内压力差显著相关。
