Kloub Martin, Látal Pavel, Giannoudis Peter
Department of Traumatology Hospital České Budějovice, Czech Republic.
Department of Traumatology Hospital České Budějovice, Czech Republic.
Injury. 2024 Jun;55(6):111473. doi: 10.1016/j.injury.2024.111473. Epub 2024 Mar 5.
A narrative review of the literature was conducted to examine the data on femoral head fractures, with a particular focus on their management, complications and clinical outcomes. A PRISMA strategy was used. Medline and Scopus library databases were queried using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. The 50 eligible articles that met the predefined inclusion criteria reported on 1403 femoral head fractures. A detailed analysis of the surgical approaches used was performed in 38 articles with 856 fractures. Most fractures were treated surgically (90,8 %) with preferred anatomical reconstruction in 76,7 % of all operatively treated cases. Posterior approaches were the most common (52.5 %). This was evenly split between surgical hip dislocation and the classic Kocher-Langenbeck approach. 70.5 % of surgically treated cases achieved excellent or good result according to Thompson-Epstein criteria. Highest rate of excellent results showed minimal invasive osteosynthesis and surgical hip dislocation. Major late complications were avascular necrosis (10.8 %), post-traumatic arthritis (16.2 %) and heterotopic ossification (20.8 %). Secondary THA was necessary in 6.9 %. Highest rate of major complications was joined with anterior approach (77 %), lowest rate from frequently used approaches surgical hip dislocation (37.8 %). Conservative treatment recedes into the background. The Ganz flip osteotomy with surgical hip dislocation allows safe treatment of all types of fractures and should be considered the first choice, offering the lowest rate of complications and one of the best functional outcomes. Reconstruction of Pipkin Type III fractures should be reserved for very young patients due to high rate of major complications.
我们进行了一项文献综述，以研究有关股骨头骨折的数据，特别关注其治疗、并发症和临床结果。采用了PRISMA策略。使用预定义的医学主题词（MeSH）和布尔运算符查询了Medline和Scopus图书馆数据库。基于牛津循证医学中心（OCEBM）和推荐分级的评估、制定与评价（GRADE）系统对证据质量进行了评估。符合预定义纳入标准的50篇合格文章报道了1403例股骨头骨折。对38篇包含856例骨折的文章中所采用的手术入路进行了详细分析。大多数骨折采用手术治疗（90.8%），在所有接受手术治疗的病例中，76.7%选择了理想的解剖重建。后入路最为常见（52.5%）。这在手术髋关节脱位和经典的Kocher-Langenbeck入路之间平均分配。根据汤普森-爱泼斯坦标准，70.5%的手术治疗病例取得了优良结果。优良率最高的是微创骨合成和手术髋关节脱位。主要的晚期并发症是股骨头缺血性坏死（10.8%）、创伤后关节炎（16.2%）和异位骨化（20.8%）。6.9%的病例需要二期全髋关节置换（THA）。主要并发症发生率最高的是前入路（77%），常用入路中手术髋关节脱位的发生率最低（37.8%）。保守治疗已退居次要地位。采用手术髋关节脱位的Ganz翻转截骨术能够安全治疗所有类型的骨折，应被视为首选，其并发症发生率最低，功能预后最佳。由于主要并发症发生率较高，Pipkin III型骨折的重建应仅适用于非常年轻患者。
