Gill T J, Sledge J B, Ekkernkamp A, Ganz R
Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
J Orthop Trauma. 1998 Sep-Oct;12(7):474-8. doi: 10.1097/00005131-199809000-00008.
To develop an intraoperative technique to predict the development of avascular necrosis after internal fixation of femoral neck fractures.
Prospective study.
All patients were treated at the same hospital.
PATIENTS/PARTICIPANTS: Sixty-four patients who presented for internal fixation of a femoral neck fracture were enrolled in the study.
A 2.0-millimeter drill was used to assess the presence and character of bleeding from the femoral head at open reduction and internal fixation of a femoral neck fracture.
Patients were evaluated postoperatively by history, examination, and roentgenography for the development of avascular necrosis of the femoral head fragment. A minimum two-year follow-up with radiography was required for entry into the study, with an average follow-up of 3.2 years.
None of the fifty-six patients with bleeding from the drill holes in the femoral head fragment developed avascular necrosis. Eight of eight patients with no bleeding after reduction developed avascular necrosis. There were no infections or nonunions.
Intraoperative drilling of the femoral head is a highly sensitive and specific predictor for the development of avascular necrosis after femoral neck fractures.
开发一种术中技术，以预测股骨颈骨折内固定术后无血管性坏死的发生。
前瞻性研究。
所有患者均在同一家医院接受治疗。
患者/参与者：64例因股骨颈骨折前来接受内固定治疗的患者纳入本研究。
在股骨颈骨折切开复位内固定时，使用2.0毫米钻头评估股骨头出血的情况及特征。
术后通过病史、检查和X线摄影评估患者股骨头碎片有无血管性坏死的发生。进入本研究需要至少两年的影像学随访，平均随访时间为3.2年。
股骨头碎片钻孔有出血的56例患者均未发生无血管性坏死。复位后无出血的8例患者中有8例发生了无血管性坏死。无感染或骨不连情况发生。
术中对股骨头进行钻孔是预测股骨颈骨折后无血管性坏死发生的一种高度敏感且特异的指标。
