老年股骨颈骨折治疗方式的临床应用进展_West China Medical Journal

Authors：

 赵文博 ,  刘雷

四川大学华西医院骨科（成都 610041）;

Corresponding author：

刘雷, Email: liuinsistence@163.com

Keywords：

股骨颈骨折; 老年人; 内固定; 人工关节置换

DOI：

10.7507/1002-0179.20150114

Video：

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随着全球逐渐步入老龄化社会，股骨颈骨折已经成为老年人最常见的疾病之一。虽然全球各地的学者都对老年股骨颈骨折作了大量的研究，治疗方式也层出不穷，但如何降低老年患者术后并发症的发生率和伤残率仍然是临床治疗上需要攻克的难点。现阶段对于老年股骨颈骨折患者的治疗方式主要分为内固定和人工关节置换两大类。常用的内固定器材包括三翼钉、空心钉、动力髋螺钉、非平行螺钉、股骨近端髓内钉、股骨近端锁定钢板等。而人工关节置换也有人工股骨头置换和全髋关节置换两类。此外，一系列治疗老年股骨颈骨折患者的辅助方法也常常应用于临床，例如关节囊切开减压、骨瓣移植、计算机辅助导航技术等。虽然治疗手段上不断修正和更新，但是仍存在着并发症多、伤残率高等问题。现就老年股骨颈骨折患者的治疗方式作一个综述，提出存在的问题，并给出解决问题的方向，以期为未来的研究提供详实可靠的依据。

Citation： 赵文博, 刘雷. 老年股骨颈骨折治疗方式的临床应用进展. West China Medical Journal, 2015, 30(2): 385-388. doi: 10.7507/1002-0179.20150114 Copy

1.	Tidermark J, Ponzer S, Svensson O, et al. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial[J]. J Bone Joint Surg Br, 2003, 85(3):380-388.
2.	Dijkman B, Kooistra B, Ferguson T, et al. Decision making:open reduction/internal fixation versus arthroplasty for femoral neck fractures[J]. Tech Orthop, 2008, 23(4):288-295.
3.	Leonardsson O, Sernbo I, Carlsson A, et al. Long-term follow-up of replacement compared with internal fixation for displaced femoral neck fractures:results at ten years in a randomised study of 450 patients[J]. J Bone Joint Surg Br, 2010, 92(3):406-412.
4.	Gjertsen JE, Vinje T, Engesaeter LB, et al. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients[J]. J Bone Joint Surg Am, 2010, 92(3):619-628.
5.	Bhandari M, Devereaux PJ, Swiontkowski MF, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis[J]. J Bone Joint Surg, 2003, 85-A(9):1673-1681.
6.	Blomfeldt R, Törnkvist H, Ponzer S, et al. Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment[J]. J Bone Joint Surg Br, 2005, 87(4):523-529.
7.	Goldstein C, Petrisor BA, Ferguson T, et al. Implants for fixation of femoral neck fractures[J]. Tech Orthop, 2008, 23(4):301-308.
8.	Stannard JP, Harris HW, Volgas DA, et al. Functional outcome of patients with femoral head fractures associated with hip dislocations[J]. Clin Orthop Relat Res, 2000, 67(377):44-56.
9.	Asnis SE, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck. Results of cannulated screw fixation[J]. J Bone Joint Surg Am, 1994, 76(12):1793-1803.
10.	Jenny JY, Rapp E, Cordey J. Type of screw dose not influence holding power in the femoral head:cadacer study with shearing test[J]. Acta Orthop Scond, 1999, 70(5):435-438.
11.	Oakey JW, Stover MD, Summers HD, et al. Does screw configuration affect subtrochanteric fracture after femoral neck fixation?[J]. Clin Orthop Relat Res, 2006, 443(1):302-306.
12.	Pelet S, Leyvraz PF, Graofalo R, et al. Sub- or intertrochanteric fracture following screw fixation of an intracapsular proximal femoral fracture:true complication or technical error?[J]. Swiss Surg, 2003, 9(2):82-86.
13.	Bhandari M, Devereaux PJ, Tornetta P, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey[J]. J Bone Joint Surg Am, 2005, 87(9):2122-2130.
14.	Bonnaire FA, Weber AT. Analysis of fracture gap changes, dynamic and static stability of different osteosynthetic procedures in the femoral neck[J]. Injury, 2002, 33(Suppl 3):C24-C32.
15.	Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of pauwels type-3 vertical femoral neck fractures[J]. J Bone Joint Surg Am, 2008, 90(8):1654-1659.
16.	Swiontkowski MF. Intracapsular fractures of the hip[J]. J Bone Joint Surg Am, 1994, 76(1):129-138.
17.	毛玉江, 危杰, 王满宜, 等. 内固定物尖端与股骨头边缘安全距离的几何学探讨[J]. 中华骨科杂志, 2009, 29(3):263-267.
18.	Madsen F, Linde F, Andersen E, et al. Fixation of displaced femoral neck fractures. A comparison between sliding screw plate and four cancellous bone screws[J]. Acta Orthop Scand, 1987, 58(3):212-216.
19.	Mitchell EJ. The technique:surgical approach and tacitics for open reduction/internal fixation of a femoral neck fracture in a young patient[J]. Tech Orthop, 2008, 23(3):296-300.
20.	Alves T, Neal JP. Biomechanical comparison of 3 possible fixation strategies to resist femoral neck shortening after fracture[J]. Orthopedics, 2010, 33(4):233-237.
21.	Visna P, Beitl E, Smídl Z, et al. Treatment of intracapsular femoral neck fractures with the use of a proximal femoral nail[J]. Acta Chir Orthop Traumatol Cech, 2007, 74(1):37-46.
22.	Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures[J]. J Bone Joint Surg Am, 2008, 90(8):1654-1659.
23.	Bhaskar D, Parker M. Preliminary results of a new dynamic locking plate and screw system for intracapsular hip fractures[J]. Injury Extra, 2008, 39(5):200.
24.	Lieberman JR, Romano PS, Mahendra G, et al. The treatment of hip fractures:variations in care[J]. Clin Orthop Relat Res, 2006, 442(1):239-244.
25.	Yamagata M, Chao EY, Ilstrup DM, et al. Fixed-head and bipolar hip endoprostheses. A retrospective clinical and roentgenographic study[J]. J Arthroplasty, 1987, 2(2):327-341.
26.	Hedbeck CJ, Enocson A, Lapidus G, et al. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures:a concise four-year follow-up of a randomized trial[J]. J Bone Joint Surg Am, 2011, 93(5):445-450.
27.	Macaulay W, Nellans KW, Iorio R, et al. Total hip arthroplasty is less painful at 12 months compared with hemiarthroplasty in treatment of displaced femoral neck fracture[J]. HSS J, 2008, 4(1):48-54.
28.	Keating JF, Grant A, Masson M, et al. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients[J]. J Bone Joint Surg Am, 2006, 88(2):249-260.
29.	Parker MJ, Gurusamy K. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults[J]. Cochrane Database Syst Rev, 2006(3):CD001706.
30.	Ryan G, Kevin M, Brett R, et al. Surgical management of hip fractures:an evidence-based review of the literature. I:femoral neck fractures[J]. J Am Acad Orthop Surg, 2008, 16(10):596-607.
31.	Clark DI, Ahmed AB, Baxendale BR, et al. Cardiac output during hemiarthroplasty of the hip. A prospective, controlled trial of cemented and uncemented prostheses[J]. J Bone Joint Surg Br, 2001, 83(3):414-418.
32.	Harper WM, Barnes MR, Gregg PJ. Femoral head blood flow in femoral neck fractures. An analysis using intra-osseous pressure measurement[J]. J Bone Joint Surg Br, 1991, 73(1):73-75.
33.	Wong TC, Yeung SH, Ip FK. The effectiveness of capsular decompression for internal fixation of intracapsular hip fractures[J]. J Orthop Surg (Hong Kong), 2007, 15(3):282-285.
34.	O'Neill F, Condon F, McGloughlin T, et al. Validity of synthetic bone as a substitute for osteoporotic cadaveric femoral heads in mechanical testing:a biomechanical study[J]. Bone Joint Res, 2012, 1(4):50-55.
35.	Okazaki N, Chiba K, Taguchi K, et al. Trabecular microfractures in the femoral head with osteoporosis:analysis of microcallus formations by synchrotron radiation micro CT[J]. Bone, 2014, 64(2):82-87.
36.	Sànchez-Riera L, Carnahan E, Vos T, et al. The global burden attributable to low bone mineral density[J]. Ann Rheum Dis, 2014, 73(9):1635-1645.
37.	Pasco JA, Lane SE, Brennan SL, et al. Fracture risk among older men:osteopenia and osteoporosis defined using cut-points derived from female versus male reference data[J]. Osteoporos Int, 2014, 25(3):857-862.
38.	Siwach RC, Rohilla R, Singh R, et al. Radiological and functional outcome in unstable, osteoporotic trochanteric fractures stabilized with dynamic helical hip system[J]. Strategies Trauma Limb Reconstr, 2013, 8(2):117-122.
39.	Grutzner PA, Suhm N. Computer aided long bone fracture treatment[J]. Injury, 2004, 35(1):57-64.

1. Tidermark J, Ponzer S, Svensson O, et al. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial[J]. J Bone Joint Surg Br, 2003, 85(3):380-388.
2. Dijkman B, Kooistra B, Ferguson T, et al. Decision making:open reduction/internal fixation versus arthroplasty for femoral neck fractures[J]. Tech Orthop, 2008, 23(4):288-295.
3. Leonardsson O, Sernbo I, Carlsson A, et al. Long-term follow-up of replacement compared with internal fixation for displaced femoral neck fractures:results at ten years in a randomised study of 450 patients[J]. J Bone Joint Surg Br, 2010, 92(3):406-412.
4. Gjertsen JE, Vinje T, Engesaeter LB, et al. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients[J]. J Bone Joint Surg Am, 2010, 92(3):619-628.
5. Bhandari M, Devereaux PJ, Swiontkowski MF, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis[J]. J Bone Joint Surg, 2003, 85-A(9):1673-1681.
6. Blomfeldt R, Törnkvist H, Ponzer S, et al. Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment[J]. J Bone Joint Surg Br, 2005, 87(4):523-529.
7. Goldstein C, Petrisor BA, Ferguson T, et al. Implants for fixation of femoral neck fractures[J]. Tech Orthop, 2008, 23(4):301-308.
8. Stannard JP, Harris HW, Volgas DA, et al. Functional outcome of patients with femoral head fractures associated with hip dislocations[J]. Clin Orthop Relat Res, 2000, 67(377):44-56.
9. Asnis SE, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck. Results of cannulated screw fixation[J]. J Bone Joint Surg Am, 1994, 76(12):1793-1803.
10. Jenny JY, Rapp E, Cordey J. Type of screw dose not influence holding power in the femoral head:cadacer study with shearing test[J]. Acta Orthop Scond, 1999, 70(5):435-438.
11. Oakey JW, Stover MD, Summers HD, et al. Does screw configuration affect subtrochanteric fracture after femoral neck fixation?[J]. Clin Orthop Relat Res, 2006, 443(1):302-306.
12. Pelet S, Leyvraz PF, Graofalo R, et al. Sub- or intertrochanteric fracture following screw fixation of an intracapsular proximal femoral fracture:true complication or technical error?[J]. Swiss Surg, 2003, 9(2):82-86.
13. Bhandari M, Devereaux PJ, Tornetta P, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey[J]. J Bone Joint Surg Am, 2005, 87(9):2122-2130.
14. Bonnaire FA, Weber AT. Analysis of fracture gap changes, dynamic and static stability of different osteosynthetic procedures in the femoral neck[J]. Injury, 2002, 33(Suppl 3):C24-C32.
15. Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of pauwels type-3 vertical femoral neck fractures[J]. J Bone Joint Surg Am, 2008, 90(8):1654-1659.
16. Swiontkowski MF. Intracapsular fractures of the hip[J]. J Bone Joint Surg Am, 1994, 76(1):129-138.
17. 毛玉江, 危杰, 王满宜, 等. 内固定物尖端与股骨头边缘安全距离的几何学探讨[J]. 中华骨科杂志, 2009, 29(3):263-267.
18. Madsen F, Linde F, Andersen E, et al. Fixation of displaced femoral neck fractures. A comparison between sliding screw plate and four cancellous bone screws[J]. Acta Orthop Scand, 1987, 58(3):212-216.
19. Mitchell EJ. The technique:surgical approach and tacitics for open reduction/internal fixation of a femoral neck fracture in a young patient[J]. Tech Orthop, 2008, 23(3):296-300.
20. Alves T, Neal JP. Biomechanical comparison of 3 possible fixation strategies to resist femoral neck shortening after fracture[J]. Orthopedics, 2010, 33(4):233-237.
21. Visna P, Beitl E, Smídl Z, et al. Treatment of intracapsular femoral neck fractures with the use of a proximal femoral nail[J]. Acta Chir Orthop Traumatol Cech, 2007, 74(1):37-46.
22. Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures[J]. J Bone Joint Surg Am, 2008, 90(8):1654-1659.
23. Bhaskar D, Parker M. Preliminary results of a new dynamic locking plate and screw system for intracapsular hip fractures[J]. Injury Extra, 2008, 39(5):200.
24. Lieberman JR, Romano PS, Mahendra G, et al. The treatment of hip fractures:variations in care[J]. Clin Orthop Relat Res, 2006, 442(1):239-244.
25. Yamagata M, Chao EY, Ilstrup DM, et al. Fixed-head and bipolar hip endoprostheses. A retrospective clinical and roentgenographic study[J]. J Arthroplasty, 1987, 2(2):327-341.
26. Hedbeck CJ, Enocson A, Lapidus G, et al. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures:a concise four-year follow-up of a randomized trial[J]. J Bone Joint Surg Am, 2011, 93(5):445-450.
27. Macaulay W, Nellans KW, Iorio R, et al. Total hip arthroplasty is less painful at 12 months compared with hemiarthroplasty in treatment of displaced femoral neck fracture[J]. HSS J, 2008, 4(1):48-54.
28. Keating JF, Grant A, Masson M, et al. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients[J]. J Bone Joint Surg Am, 2006, 88(2):249-260.
29. Parker MJ, Gurusamy K. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults[J]. Cochrane Database Syst Rev, 2006(3):CD001706.
30. Ryan G, Kevin M, Brett R, et al. Surgical management of hip fractures:an evidence-based review of the literature. I:femoral neck fractures[J]. J Am Acad Orthop Surg, 2008, 16(10):596-607.
31. Clark DI, Ahmed AB, Baxendale BR, et al. Cardiac output during hemiarthroplasty of the hip. A prospective, controlled trial of cemented and uncemented prostheses[J]. J Bone Joint Surg Br, 2001, 83(3):414-418.
32. Harper WM, Barnes MR, Gregg PJ. Femoral head blood flow in femoral neck fractures. An analysis using intra-osseous pressure measurement[J]. J Bone Joint Surg Br, 1991, 73(1):73-75.
33. Wong TC, Yeung SH, Ip FK. The effectiveness of capsular decompression for internal fixation of intracapsular hip fractures[J]. J Orthop Surg (Hong Kong), 2007, 15(3):282-285.
34. O'Neill F, Condon F, McGloughlin T, et al. Validity of synthetic bone as a substitute for osteoporotic cadaveric femoral heads in mechanical testing:a biomechanical study[J]. Bone Joint Res, 2012, 1(4):50-55.
35. Okazaki N, Chiba K, Taguchi K, et al. Trabecular microfractures in the femoral head with osteoporosis:analysis of microcallus formations by synchrotron radiation micro CT[J]. Bone, 2014, 64(2):82-87.
36. Sànchez-Riera L, Carnahan E, Vos T, et al. The global burden attributable to low bone mineral density[J]. Ann Rheum Dis, 2014, 73(9):1635-1645.
37. Pasco JA, Lane SE, Brennan SL, et al. Fracture risk among older men:osteopenia and osteoporosis defined using cut-points derived from female versus male reference data[J]. Osteoporos Int, 2014, 25(3):857-862.
38. Siwach RC, Rohilla R, Singh R, et al. Radiological and functional outcome in unstable, osteoporotic trochanteric fractures stabilized with dynamic helical hip system[J]. Strategies Trauma Limb Reconstr, 2013, 8(2):117-122.
39. Grutzner PA, Suhm N. Computer aided long bone fracture treatment[J]. Injury, 2004, 35(1):57-64.

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老年股骨颈骨折治疗方式的临床应用进展

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