摘要
目的总结成人股骨转子间骨折术后股骨头坏死(osteonecrosis of femoral head,ONFH)研究进展。方法广泛查阅国内外相关文献,总结成人股骨转子间骨折术后ONFH发病机制、高危因素及治疗方式。结果股骨转子间骨折术后ONFH多发生在术后2年内,发生率较低。目前认为高能量损伤导致的粉碎骨折及移位较大的骨折、接近基底部的骨折类型、患肢过度外旋畸形、髓内钉进针点不当,以及术中可能影响旋股内侧动脉深支血供的暴力操作,是导致股骨转子间骨折术后ONFH的高危因素。坏死后治疗以髋关节置换为主,可取得良好效果。结论针对以上风险,伤后要避免过度外旋、过度牵引、暴力操作,术中要解剖复位,进针点精确,避免反复钻孔,导致热损伤。
Objective To summarize the research progress of osteonecrosis of femoral head(ONFH)following femoral intertrochanteric fractures in adults.Methods Relevant literature at home and abroad was extensively reviewed to summarize the pathogenesis,high-risk factors,and treatment of ONFH after femoral intertrochanteric fracture in adults.Results ONFH after femoral intertrochanteric fracture mostly occurs within 2 years after operation,with a lower incidence.At present,it is believed that comminuted and large displacement fractures caused by high-energy injuries,fracture line close to the base of neck,excessive external rotation deformity,improper intramedullary nail entry points,and rough intraoperative manipulating may injury the deep branch of the medial circumflex femoral artery,causing ONFH.Hip replacement is the main treatment for necrosis,which can achieve good results.Conclusion Addressing the above risks,excessive external rotation,overstretching,and rough manipulating should be avoided.Anatomical reduction should be performed during the operation,the nail entry point should be accurate and avoid repeated drilling and thermally bone necrosis.
作者
姜钰
黄鑫
朱颖波
王晓宁
吴克俭
JIANG Yu;HUANG Xin;ZHU Yingbo;WANG Xiaoning;WU Kejian(Department of Orthopedics,the Forth Medical Center of Chinese PLA General Hospital,Beijing,100048,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第11期1458-1461,共4页
Chinese Journal of Reparative and Reconstructive Surgery
基金
首都临床特色应用研究(Z181100001718001)。
关键词
股骨转子间骨折
股骨头坏死
发病机制
高危因素
Femoral intertrochanteric fracture
osteoecrosis of femoral head
pathogenesis
high-risk factor
