UT Health San Antonio, Department of Orthopaedics, San Antonio, TX, USA.
UT Health San Antonio, Long School of Medicine, San Antonio, TX, USA.
Int Orthop. 2022 May;46(5):1111-1122. doi: 10.1007/s00264-022-05314-3. Epub 2022 Feb 21.
This review paper on femoral neck fractures in the elderly provides updated information from the most recent literature and examines the advantages and disadvantages of different surgical treatment options. Femoral neck fractures are a common injury that many orthopaedic surgeons will encounter within their practice. These injuries are associated with significant morbidity, and the economic impact of surgically fixing these fractures is notable. Contemporary treatment options include internal fixation, hemiarthroplasty, and total hip arthroplasty. For non-displaced fractures, both internal fixation and hemiarthroplasty remain feasible options. Hemiarthroplasty decreases re-operation rate, while internal fixation decreases operative time, blood loss, and infection risk. Newly designed fixation constructs require further investigation. For displaced fractures, the literature strongly supports arthroplasty. Most elderly patients with displaced femoral neck fractures should be managed with a hemiarthroplasty. In select active elderly patients, total hip arthroplasty may achieve favourable early functional outcomes as compared to a hemiarthroplasty. Finally, cemented arthroplasty decreases periprosthetic fracture risk as compared to cementless arthroplasty. However, experienced arthroplasty surgeons with significant expertise in press-fitting techniques may achieve similar outcomes with cementless arthroplasty.
这篇关于老年股骨颈骨折的综述文章提供了最新文献的更新信息，并探讨了不同手术治疗选择的优缺点。股骨颈骨折是一种常见的损伤，许多骨科医生在其临床实践中都会遇到。这些损伤与显著的发病率相关，手术治疗这些骨折的经济影响是显著的。当代治疗选择包括内固定、人工股骨头置换和全髋关节置换。对于无移位骨折，内固定和人工股骨头置换仍然是可行的选择。人工股骨头置换术降低了再次手术的发生率，而内固定术降低了手术时间、失血量和感染风险。新设计的固定结构需要进一步研究。对于移位骨折，文献强烈支持关节置换。大多数有移位的股骨颈骨折的老年患者应采用人工股骨头置换术治疗。在选择的活跃的老年患者中，与人工股骨头置换术相比，全髋关节置换术可能会获得更好的早期功能结果。最后，与非骨水泥型假体相比，骨水泥型假体降低了假体周围骨折的风险。然而，具有压配技术丰富专业知识的有经验的关节置换外科医生可能会通过非骨水泥型假体获得类似的结果。
