University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine Department of Orthopaedic Trauma Surgery. 11100 Euclid Ave Cleveland, OH 44106. USA.
University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine Department of Orthopaedic Trauma Surgery. 11100 Euclid Ave Cleveland, OH 44106. USA.
Injury. 2021 Apr;52(4):647-652. doi: 10.1016/j.injury.2021.02.046. Epub 2021 Feb 18.
There is no recent literature review comparing outcomes of fixation methods for nondisplaced stress fractures of the femoral neck.
A systematic review of the literature on operative fixation of femoral neck stress fractures was performed. Inclusion criteria consisted of diagnosis of nondisplaced femoral neck stress fractures, implants used for fixation, articles in English language or available English translation, all ages, and Level 1-5 evidence, documented time to healing, and incidence of complications. Statistical analysis was performed to compare outcomes.
Eight studies with 13 subjects and 15 fractures undergoing operative fixation were included. Six fracture were compression sided, five were tension sided, and four were complete. Radiographic healing occurred on average at 32.7 ± 36.3 weeks (range 8-121 weeks). Four subjects were noted to have a metabolic disturbance. Six subjects did not participate in vigorous exercise. There were no complications. There was no significant difference in radiographic healing time between: cannulated screws or SHS ± osteotomy (p = 0.21); compression sided, tension sided, or complete fractures (p = 0.41); ages (p = 0.09); sex (p = 0.09) or individuals with or without metabolic disturbances (p = 0.92). There was no difference between use of cannulated screw fixation, SHS + osteotomy, and SHS alone based on the subject's age (p = 0.27) or cannulated screw vs SHS ± osteotomy given subject's age (p = 0.19) or sex (p = 1.0). Time to full weight bearing (FWB) did not significantly differ between implants (p = 0.22). However, >8 weeks restricted weight bearing had increased healing times (p = 0.002).
Time to healing was not dependent on subjects' sex or age, fracture location, implant choice, or presence of metabolic abnormality. No complications were reported. Time to full weight bearing was not dependent on implant choice. However, restricted weight bearing beyond 8 weeks can lead to prolonged healing times. Fixation should be safe, effective and promote early weight bearing and mobilization.
目前尚无比较股骨颈非移位性应力骨折固定方法结果的最新文献综述。
对股骨颈应力骨折手术固定的文献进行了系统回顾。纳入标准包括诊断为非移位性股骨颈应力骨折、使用的固定植入物、英文文献或可提供英文翻译的文献、所有年龄段、1-5 级证据、记录愈合时间和并发症发生率。进行了统计学分析以比较结果。
纳入 8 项研究，共 13 例患者，15 处骨折接受手术固定。6 处骨折位于压缩侧，5 处位于张应力侧，4 处为完全性骨折。平均 X 线愈合时间为 32.7±36.3 周（8-121 周）。4 例患者存在代谢紊乱。6 例患者未参加剧烈运动。无并发症。在 X 线愈合时间方面，空心螺钉或 SHS ± 截骨术（p=0.21）、压缩侧、张应力侧或完全性骨折（p=0.41）、年龄（p=0.09）、性别（p=0.09）或是否存在代谢紊乱（p=0.92）之间无显著差异。根据患者年龄（p=0.27）或患者年龄与空心螺钉与 SHS ± 截骨术（p=0.19）或性别（p=1.0），空心螺钉固定、SHS+截骨术与 SHS 单独固定之间无差异。完全负重（FWB）时间在植入物之间无显著差异（p=0.22）。然而，限制负重超过 8 周会增加愈合时间（p=0.002）。
愈合时间与患者的性别或年龄、骨折部位、植入物选择或代谢异常无关。未报告并发症。完全负重时间与植入物选择无关。然而，限制负重超过 8 周会导致愈合时间延长。固定应安全有效，并促进早期负重和活动。
