Mavrogenis Andreas F, Kouvidis George, Stavropoulos Nikolaos A, Stavrakakis Loannis, Katonis Pavlos, Papagelopoulos Panayiotis J
First Department of Orthopaedics, Athens University Medical School, Athens, Greece.
J Long Term Eff Med Implants. 2012;22(1):1-10. doi: 10.1615/jlongtermeffmedimplants.v22.i1.10.
Hip fractures are associated with significant mortality and morbidity for the patients, more dependent residual status, and increased socio-economic cost. Many hip-fracture patients experience severe functional impairment, and most never recover their pre-fracture level of function. Current research has sought to identify the most effective treatments to reduce the incidence of hip fractures, improve survival and quality of life, and minimize complications and disability. The treatment of these fractures in the elderly aims to return these people to their pre-fracture mobility and functional level. This article reviews the surgical treatment options for extracapsular hip fractures and discusses their associated advantages, disadvantages, and complications. Two types of implants are currently available: the dynamic hip screw (DHS), and the intramedullary hip nail with one or two sliding screws. In this review, no clear advantage of one implant over another for the treatment of extracapsular hip fractures was evident. Both the DHS and hip nails can be used successfully for the treatment of stable hip fractures; for unstable fractures and low subtrochanteric fractures, hip nails are preferred. Although hip nails are associated with limited exposure, lower blood loss and transfusion requirements, and shorter operative time, complications are more common with hip nails. Long-term survival and function are similar in the two approaches. Hip nails with two sliding screws do not seem to make the difference in clinical practice that is reported in biomechanical studies.
髋部骨折会给患者带来显著的死亡率和发病率，导致更多的依赖残留状态，并增加社会经济成本。许多髋部骨折患者会经历严重的功能障碍，而且大多数人无法恢复到骨折前的功能水平。当前的研究致力于确定最有效的治疗方法，以降低髋部骨折的发生率、提高生存率和生活质量，并将并发症和残疾降至最低。老年患者髋部骨折的治疗旨在使他们恢复到骨折前的活动能力和功能水平。本文综述了囊外髋部骨折的手术治疗选择，并讨论了它们的相关优点、缺点和并发症。目前有两种类型的植入物：动力髋螺钉（DHS）和带有一个或两个滑动螺钉的髓内髋钉。在本综述中，对于囊外髋部骨折的治疗，一种植入物相对于另一种植入物并无明显优势。DHS和髋钉均可成功用于治疗稳定的髋部骨折；对于不稳定骨折和低位转子下骨折，首选髋钉。尽管髋钉的手术暴露有限、失血量和输血需求较低且手术时间较短，但髋钉的并发症更为常见。两种方法的长期生存率和功能相似。在临床实践中，带有两个滑动螺钉的髋钉似乎并未产生生物力学研究中所报道的差异。
