股骨颈骨折内固定术后股骨颈短缩的相关研究进展  

Advances on preventing femoral neck shortening after internal fixation of femoral neck fracture

作　　者：李伟龙[1] 余霄[2] 庞清江[2] 

机构地区：[1]宁波大学医学院,315211 [2]宁波市第二医院骨科中心,315010

出　　处：《中华骨科杂志》2016年第6期378-384,共7页Chinese Journal of Orthopaedics

基　　金：浙江省医药卫生科技计划（2015ZDA026,2014KYB234）

摘　　要：股骨颈骨折术后颈短缩可引起髋关节功能障碍，本综述收集相关文献，总结股骨颈骨折内固定术后颈短缩的发生率、短缩程度的测量方法、颈短缩影响因素以及防治措施。由于滑动加压系统自身的内固定机制，其相对于股骨颈长度稳定系统有更高颈短缩发生率，并伴有较高的短缩量，而股骨颈长度稳定系统，如股骨近端髓内钉、股骨近端锁定钢板等可以维持股骨颈长度的内固定系统的疗效，但仍需大规模的研究进行验证。颈短缩的程度主要靠影像学测量，目前的测量方法包括股骨头位移变化、XYZ轴测量法、外露螺钉长度测量以及股骨头塌陷测量法，而体位、拍摄角度和这几种设计方法本身的缺陷都会给测量带来误差。因此，也还需要继续探索来寻找一种操作简单、适用范围广，又具有一定准确性的测量方法。患者在骨折时的自身情况、骨折类型、复位质量和手术方式都会在一定程度上影响颈短缩，虽然个别研究有相互矛盾的地方，但总体来说，老年女性，伴有移位或粉碎性骨折、术后未达到良好复位都将会增加股骨颈短缩的风险及其短缩量，其中探索不同内固定方式来预防短缩成为近几年的热点，包括对滑动加压系统装置的改造以及新型内固定方式的设计，但结果却不尽相同，如何将这几种内固定装置有机的结合在一起来降低颈短缩的发生率和短缩量可能会是今后的一个发展方向。同时，生物制剂联合内固定的方法能否预防颈短缩还处于前期的摸索阶段。在现有的研究下，还未发现为治疗股骨颈短缩而设计的手术方式，虽然股骨转子下截骨术在治疗股骨颈骨折不愈合的同时还能纠正严重颈短缩导致的双下肢不等长，但是该术式并没有恢复股骨颈长度，因此，对于已经影响髋关节功能的轻微颈短缩的疗效如何还有待探索。Femoral head necrosis and nonunion is a common complication after surgery of femoral neck fracture. Recently, femoral neck shortening have caused attentions which can impact the function of hip. Incidence,mearsurement ,influence factor, prevention and treatment of femoral neck shortening have been retrospective reviewed. Amount of femoral neck shortening with sliding compression system is significantly more than length of stability system, which is result from its own mechanism. However, effcacy of length of stability system still need a large scale of sample. It uses radiography to diagnose shortening. The present measurement methods include displacement of femoral head, xyz-axis measurement, the length of exposed screw, the collapse of femoral head. However, position, the angle of screen and the defect of the method would increase deviation. A measurement with simple, wide application and accuracy need to continue to explore. Apart from patients＇ condition, shortening also affected by the pattern and quality of surgery. Overall, older women, displacement fracture, unsatisfactory reduction will increase the risk and shrinkage of shortening. In addition, the pattern of the internal fixation becomes the research focus in the field of orthopedic clinical research. Including the transformation of sliding compression system device and design of novel device. How to combine them together organically could be a future development direction. Meanwhile, there are still in exploratory stage to decide whether biological combined with internal fixation can prevent shortening. Intertrochanteric osteotomy can achieve union and correct the limb-length discrepancy, However, it did not restore the length of femoral neck. So, it is unknown that whether the method can solve the slight shortening which have impacted the hip function.

关 键 词：股骨颈骨折术后 骨折内固定术后 短缩 髋关节功能障碍 股骨近端髓内钉 影像学测量 内固定系统 长度测量 

分 类 号：R687.3[医药卫生—骨科学]