Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
Orthop Surg. 2022 Aug;14(8):1759-1767. doi: 10.1111/os.13378. Epub 2022 Jul 11.
To investigate associations between femoral head necrosis (FHN) and injury to the retinaculum of Weitbrecht in patients with femoral neck fractures who had undergone initial trials of either closed reduction or direct open reduction.
This prospective observational study included 110 patients with displaced femoral neck fractures admitted to the Sixth People's Hospital Affiliated to Shanghai Jiaotong University and Shanghai Tongji Hospital between January 2008 and May 2017. Among these, 25 patients underwent initial closed reductions, and 85 patients underwent an open reduction directly. Watson-Jones anterolateral approach was used during the surgery for injury to the retinaculum of Weitbrecht, and FHN was assessed as a surgical outcome. The severity of injury to the retinaculum of Weitbrecht was evaluated using a scoring system developed by our surgical team. Follow-up was at least 24 months.
The initial closed reduction treatment group had significantly higher total scores of injury to the retinaculum of Weitbrecht (6.24 ± 2.20 vs 4.62 ± 2.12, p = 0.009) compared to the open reduction group. High total scores were significantly associated with initial trials of closed reduction treatment, especially for the broken and released injury to the superior and anterior retinacula (both p = 0.01). Twenty-six patients experienced FHN postoperatively, with mean onset time of 19.42 ± 3.87 months. FHN was significantly associated with the severity of injury to the retinaculum of Weitbrecht (p < 0.001) at the superior, anterior, and inferior retinacula. FHN was significantly associated with injury to the retinaculum of Weitbrecht in females.
Femoral neck displacement in patients treated initially with closed reduction is associated with subsequent injury to the retinaculum of Weibrecht, which may lead to FHN. Severity of injury to the retinaculum of Weibrecht may be used as a biomarker to evaluate bone necrosis in patients with femoral neck fractures.
探讨在接受闭合复位或直接切开复位初次尝试的股骨颈骨折患者中，股骨头坏死（FHN）与 Weitbrecht 韧带上的损伤之间的关系。
这是一项前瞻性观察研究，纳入了 2008 年 1 月至 2017 年 5 月期间在上海交通大学附属第六人民医院和上海同济大学医院就诊的 110 例移位性股骨颈骨折患者。其中，25 例行闭合复位，85 例行直接切开复位。手术中采用 Watson-Jones 前外侧入路治疗 Weitbrecht 韧带上的损伤，并将 FHN 作为手术结果进行评估。我们的手术团队制定了一个评分系统来评估 Weitbrecht 韧带上的损伤严重程度。随访时间至少 24 个月。
与切开复位组相比，闭合复位组的 Weitbrecht 韧带上的损伤总评分明显更高（6.24±2.20 比 4.62±2.12，p=0.009）。高总评分与闭合复位治疗的初次尝试显著相关，尤其是对于上、前侧 Weitbrecht 韧带上的撕裂和释放损伤（均 p=0.01）。26 例患者术后发生 FHN，平均发病时间为 19.42±3.87 个月。FHN 与 Weitbrecht 韧带上的损伤严重程度显著相关（p<0.001），包括上、前、下侧 Weitbrecht 韧带上的损伤。FHN 与女性患者的 Weitbrecht 韧带上的损伤显著相关。
接受闭合复位治疗的患者的股骨颈移位与随后的 Weitbrecht 韧带上的损伤有关，这可能导致 FHN。Weitbrecht 韧带上的损伤严重程度可作为评估股骨颈骨折患者骨坏死的生物标志物。
