Kim Chul-Ho, Kim Ji Wan
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Clin Orthop Trauma. 2024 Jul 17;54:102497. doi: 10.1016/j.jcot.2024.102497. eCollection 2024 Jul.
Femoral neck fractures present significant challenges in orthopedic surgery, particularly due to technical difficulties and a high complication rate. Surgical intervention is generally recommended, with osteosynthesis and arthroplasty being the main treatment options. Osteosynthesis techniques, including dynamic hip screw (DHS), multiple cannulated screws (MCS), and the femoral neck system (FNS), aim to achieve stable fixation and facilitate fracture healing. Factors influencing the choice of osteosynthesis include fracture displacement, bone quality, patient age, and the presence of posterior tilt. While DHS offers high stability, MCS is preferred in stable type fractures with minimal invasive procedures. FNS, a newer technique, combines the advantages of DHS and MCS, providing strong fixation with minimal soft tissue damage. Considering the comprehensive findings of biomechanical and clinical studies to date, when performing osteosynthesis for unstable femoral neck fractures, caution should be exercised with MCS as it may have slightly inadequate fixation strength compared to DHS and FNS. FNS, being the newest technique, demonstrates superior fixation strength comparable to DHS and is as minimally invasive as MCS. However, it is essential to remember that long-term follow-up results are lacking for FNS.
股骨颈骨折在骨科手术中面临重大挑战，特别是由于技术难题和高并发症发生率。一般建议进行手术干预，接骨术和关节成形术是主要的治疗选择。接骨术技术，包括动力髋螺钉（DHS）、多枚空心螺钉（MCS）和股骨颈系统（FNS），旨在实现稳定固定并促进骨折愈合。影响接骨术选择的因素包括骨折移位、骨质、患者年龄以及后倾情况。虽然DHS提供高稳定性，但MCS在稳定型骨折且手术创伤最小的情况下更受青睐。FNS是一种较新的技术，结合了DHS和MCS的优点，在软组织损伤最小的情况下提供强大的固定。考虑到迄今为止生物力学和临床研究的综合结果，在对不稳定股骨颈骨折进行接骨术时，应谨慎使用MCS，因为与DHS和FNS相比，其固定强度可能略显不足。FNS作为最新的技术，显示出与DHS相当的卓越固定强度，并且与MCS一样微创。然而，必须记住，FNS缺乏长期随访结果。
