Goodman S B, Schatzker J
Can J Surg. 1986 Sep;29(5):351-6.
To determine the adequacy of reduction and the soundness of the technique of primary internal fixation, the authors studied prospectively 96 femoral neck fractures over 6 1/2 years. Patients were followed up for an average of 11 months. The mean patient age was 70 years. Both clinical and radiologic data were collected at 3-month intervals for 6 months and then annually. Radiologic indices recorded included the Garden classification and index, shear angle, Western Infirmary Glasgow angle, lateral angle, nail placement, occurrence of bony union and presence of avascular necrosis. The fixation devices included sliding compression screw and side plate, multiple Knowles pins and a 130 degrees AO blade plate. A high rate of varus reduction, excessive ante- or retroversion and poor nail placement were all noted. Twenty-three patients required a total of 36 reoperations. There were six deaths in the first 6 months after operation. Eighty-five patients (mean age 79 years) with femoral neck fractures treated by hemiarthroplasty (71) or total hip replacement (14) during the same period were also reviewed. Follow-up averaged 8 months. Two patients required reoperation. The general morbidity was similar to that of the group treated by internal fixation, but there were eight deaths. Femoral neck fractures, if treated by internal fixation, demand accurate reduction and fixation for optimum results. Primary prosthetic replacement should be reserved for elderly patients with poor bone stock.
为了确定复位的充分性及一期内固定技术的可靠性，作者在6年半的时间里对96例股骨颈骨折患者进行了前瞻性研究。患者平均随访11个月。患者的平均年龄为70岁。在6个月内每3个月收集一次临床和放射学数据，之后每年收集一次。记录的放射学指标包括Garden分型和指数、剪切角、格拉斯哥西部医院角、外侧角、钉的位置、骨愈合情况及有无缺血性坏死。固定器械包括滑动加压螺钉和侧板、多根Knowles针以及130°AO角钢板。发现内翻复位率高、前倾角或后倾角过大以及钉位置不佳的情况均很常见。23例患者共需要36次再次手术。术后前6个月有6例死亡。同期对85例（平均年龄79岁）接受半髋关节置换术（71例）或全髋关节置换术（14例）治疗的股骨颈骨折患者也进行了回顾性研究。平均随访8个月。2例患者需要再次手术。总体发病率与内固定治疗组相似，但有8例死亡。股骨颈骨折若采用内固定治疗，需要精确复位和固定以获得最佳效果。一期假体置换应保留给骨质条件差的老年患者。
