内固定和关节置换治疗老年股骨颈骨折:如何体现个体化的精准治疗  

Internal fixation and arthroplasty for femoral neck fracture in the elderly:how to reflect individualized precision treatment

作　　者：王德斌 毕郑刚[1] Wang Debin;Bi Zhenggang(Department of Orthopedics,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,Heilongjiang Province,China)

机构地区：[1]哈尔滨医科大学附属第一医院骨科,黑龙江省哈尔滨市150001

出　　处：《中国组织工程研究》2021年第27期4395-4400,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:手术治疗为老年股骨颈骨折治疗的主要手段,内固定和关节置换的选择是目前具有较大争论的焦点问题。目的:对在老年股骨颈骨折手术治疗中内固定和关节置换两方面的研究进展进行深入分析和总结。方法:由第一作者以中文检索词“股骨颈骨折,内固定,关节置换,老年人”和英文检索词“femoral neck fracture;internal fixation;arthroplasty;elderly”,在Web of Science、PubMed和中国知网(CNKI)数据库中检索2001年1月至2020年8月期间收录的相关文献。筛选和整理检索的相关文献,将纳入的相关文献进行详细地综述。结果与结论:老年股骨颈骨折手术方式主要为内固定和关节置换,两者均有各自的优势,如何选择手术方式仍然有待明晰。由于关节置换能使股骨颈骨折的老年患者术后尽快地下地活动,避免了因长期卧床而出现的一系列不良后果,关节置换几乎成为老年患者的“代名词”。此外,骨折分型也是一个重要因素,通常GardenⅠ型和Ⅱ型骨折倾向于切开复位内固定,而GardenⅢ、Ⅳ型骨折则是关节置换。这一点也并不绝对,体质较佳、股骨头血供未被破坏、骨折愈合能力较强的老年患者,除了严重粉碎无法复位外,通常会优先考虑内固定,此时需注意如何有效固定,必要时结合Pauwels角。因此,除了年龄和/或骨折分型,股骨头血运、骨质量、骨愈合能力、身体条件、个人意愿和习俗等问题也影响手术方式的选择。许多学者所提倡的这种多因素综合分析,更注重个体化差异的特殊性,体现了个体化的精准治疗,也是今后老年股骨颈骨折手术治疗进一步深入研究的方向之一。BACKGROUND:Surgical treatment has become the main method for the treatment of femoral neck fractures in the elderly,but the choice of internal fixation and arthroplasty is still the focus of great debate.OBJECTIVE:To analyze and summarize the research progress of internal fixation and arthroplasty for the femoral neck fracture in the elderly.METHODS:The first author used the Chinese and English search terms“femoral neck fracture,internal fixation,arthroplasty,the elderly”in Web of Science,PubMed and China National Knowledge Infrastructure(CNKI)to search the relevant literature collected from January 2001 to August 2020.The relevant documents were screened and sorted out,and the included relevant articles were reviewed in detail.RESULTS AND CONCLUSION:Internal fixation and arthroplasty are the main surgical methods for elderly femoral neck fracture,both of which have their own advantages,so how to choose is still unclear.Because arthroplasty can make the elderly patients with femoral neck fracture move underground as soon as possible after operation and avoid a series of adverse consequences caused by long-term bed rest.Arthroplasty has almost become the“pronoun”.In addition,fracture type is also an important factor.Usually,the Garden I and II tend to open reduction and internal fixation,while arthroplasty is used for Garden type III and IV.This is not absolute.In addition to severe comminution and irreducible reduction,the elderly patients with good constitution,undamaged blood supply of femoral head and strong fracture healing ability usually give priority to internal fixation.At the same time,it is necessary to pay attention to how to fix it effectively,and if necessary,to combine the Pauwels angle.Therefore,in addition to age and/or fracture type,issues such as femoral head blood flow,bone quality,bone healing ability,physical conditions,personal wishes and customs also influence the choice of surgical approach.The multi-factor comprehensive analysis advocated by many scholars pays more attention to th

关 键 词：股骨颈骨折 内固定 关节置换 老年人 空心钉 假体类型 双极人工股骨头 双动全髋置换 综述 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]