老年不稳定型股骨转子间骨折的研究治疗进展
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摘要
随着预期寿命的延长和医疗技术的进步,老年股骨转子间骨折的发病率也急剧增加,老年人由于其特性,转子间骨折常呈现不稳定型。稳定型转子间骨折治疗上已经取得临床共识,但是不稳定转子间骨折的治疗争议仍然较大。因此,为这种骨折提供持久坚强的固定,有关于理想植入物的选择多年来一直是持续研究的话题。髓内植入因其生物力学方面的优势可提供良好的稳定性,并且在减少术中软组织损伤和术后并发症等方面令人满意而常被选择用来治疗此类型骨折。21世纪引入了股骨近端锁定压迫板(PF-LCP)为髓内植入困难或不适用于复杂骨折模型时或髓腔狭窄不适合髓内植入的患者提供了另一种选择的可能性。一些外科医生建议采用人工关节置换术治疗不稳定股骨转子间骨折,因其允许术后早期负重和快速康复,避免了术后卧床并发症和内固定物翻修的可能性。我们查阅当前国内外文献,综述此类治疗现状,为临床研究提供参考。
With the extension of life expectancy and medical technology, the incidence of intertrochanteric fractures in the elderly is also increasing,Intertrochanteric fractures are often unstable because of senile age.Stable intertrochanteric fractures have achieved clinical consensus, but the treatment of unstable intertrochanteric fractures is still controversial.Therefore, to provide a lasting, strong fixation for such fractures, the selection of ideal implants has been a topic of ongoing research for many years.Intramedullary fixation provides good stability due to its biomechanical advantages and is often chosen to treat this type of fracture in terms of reducing intraoperative soft tissue damage and postoperative complications.The introduction of the proximal femoral locking compression plate(PF-LCP) in the 21 st century offers the possibility of an alternative for patients with intramedullary implants or who are not suitable for complex fracture models or whose medullary stenosis is not suitable for intramedullary implantation. Some surgeons recommend that arthroplasty be used to treat unstable femoral intertrochanteric fractures because it allows for early postoperative weight-bearing and rapid recovery, avoiding the possibility of postoperative complications and internal fixation revision. We searched and read the current Chinese and English literature to review the current treatment of these fractures and provide a reference for clinical research.
With the extension of life expectancy and medical technology, the incidence of intertrochanteric fractures in the elderly is also increasing,Intertrochanteric fractures are often unstable because of senile age.Stable intertrochanteric fractures have achieved clinical consensus, but the treatment of unstable intertrochanteric fractures is still controversial.Therefore, to provide a lasting, strong fixation for such fractures, the selection of ideal implants has been a topic of ongoing research for many years.Intramedullary fixation provides good stability due to its biomechanical advantages and is often chosen to treat this type of fracture in terms of reducing intraoperative soft tissue damage and postoperative complications.The introduction of the proximal femoral locking compression plate(PF-LCP) in the 21 st century offers the possibility of an alternative for patients with intramedullary implants or who are not suitable for complex fracture models or whose medullary stenosis is not suitable for intramedullary implantation. Some surgeons recommend that arthroplasty be used to treat unstable femoral intertrochanteric fractures because it allows for early postoperative weight-bearing and rapid recovery, avoiding the possibility of postoperative complications and internal fixation revision. We searched and read the current Chinese and English literature to review the current treatment of these fractures and provide a reference for clinical research.
引文
[1]Yoon HK,Park C,Jang S,et al.Incidence and mortality following hip fracture in Korea[J].J Korean Med Sci,2011,26:1087-92.
[2]Centers for Disease Control and Prevention.Hip fractures among older adults.2014.Available at:http://www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html.
[3]Zhang K,Zhang S,Yang J,et al.Proximal femoral nail vs.dynamic hip screw in treatment of intertrochanteric fractures:a meta-analysis[J].Med Sci Monit,2014,20:1628-33.
[4]Adams CI,Robinson CM,Court-Brown CM et al.Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate of intertrochanteric fractures of the femur[J].J Orthop Trauma,2001,15:394-400.
[5]Haidukewych GJ,Israel TA,Berry DJ.Reverse obliquity fractures of the intertrochanteric region of the femur[J].J Bone Joint Surg Am,2001,83-A:643-50.
[6]Kashigar A,Vincent A,Gunton MJ,et al.Predictors of failure for cephalomedullary nailing of proximal femoral fractures[J].Bone Joint J,2014,96-B:1029-1034.
[7]Dhamangaonkar AC,Joshi D,Goregaonkar AB,et al.Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures[J].J Orthop Surg,2013,21:317-322.
[8]Abdelkhalek M,Ali AM.Cemented bipolar hemiarthroplasty with a cerclage cable technique for unstable intertrochanteric hip fractures in elderly patients[J].Eur J Orthop Traumatol,2013,23(4),443-448.
[9]Stappaerts KH,Deldycke J,Broos PL,et al.Treatment of unstable peritrochanteric fractures in elderly patients with a compression hip screw or with the Vandeputte(VDP)endoprosthesis:a prospective randomized study[J].J Orthop Trauma,1995,9(4):292-7.
[10]Lindskog DM,Baumgaertner MR.Unstable intertrochanteric hip fractures in the elderly[J].J Am Acad Orthop Surg,2004,12(3):179-90.
[11]Evans EM.The treatment of trochanteric fractures of the femur[J].J Bone Joint Surg Br,1949,31B(2):190-203.
[12]Marsh JL,Slongo TF,Agel J,et al.Fracture and dislocation classification compendium-2007:Orthopaedic Trauma Association classification,data base and outcomes committee[J].J Orthop Trauma,2007,21(10):S1-133.
[13]Boyd HB,Griffin LL.Classification and treatment of trochanteric fractures[J].Arch Surg,1949,58:853-66
[14]Kokoroghiannis C,Aktselis I,Deligeorgis A,et al.Pappadas I Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures-a review[J].Injury,2012,43(6):686-693.
[15]Socci AR,Casemyr NE,Leslie MP,et al.Implant options for the treatment of intertrochanteric fractures of the hip:rationale,evidence,and recommendations[J].Bone Joint J,2017,99-B(1):128-33.
[16]Rethnam U,Cordell-Smith J,Kumar TM,et al.Complex proximal femoral fractures in the elderly managed by reconstruction nailing-complications and outcomes:a retrospective analysis[J].J Trauma Manag Outcomes,2007,1(7):1-7.
[17]Hohendorff B,Meyer P,Menezes D,et al.Treatment results and complications after PFN osteosynthesis[J].Unfallchirurg,2005,108(11):938,940,941-46.
[18]Simmermacher RK,Ljungqvist J,Bail H,et al.The new proximal femoral nail antirotation(PFNA)in daily practice:results of a multicentre clinical study[J].Injury,2008,39:932-9.
[19]Raviraj A,Anand A,Chakravarthy M,et al.Proximal femoral nail antirotation(PFNA)for treatment of osteoporotic proximal femoral fractures[J].Eur J Orthop Surg Traumatol,2012,22:301-05.
[20]Mereddy P,Kamath S,Ramakrishnan M,et al.The AO/ASIF proximal femoral nail antirotation(PFNA):a new design for the treatment of unstable proximal femoral fractures[J].Injury,2009,40:428-32.
[21]Sahin S,Ertürer E,Oztürk I,et al.Radiographic and functional results of osteosynthesis using the proximal femoral nail antirotation(PFNA)in the treatment of unstable intertrochanteric femoral fractures[J].Acta Orthop Traumatol Turc,2010,44:127-34.
[22]Ruecker AH,Rupprecht M,Gruber M,et al.The treatment of intertrochanteric fractures:results using an intramedullary nail with integrated cephalocervical screws and linear compression[J].J Orthop Trauma,2009,1:22-30
[23]Ma CH,Tu YK,Yu SW,et al.Reverse LISS plates for unstable proximal femoral fractures[J].Injury,2010,41:827-833.
[24]Schneider K,Oh JK,Zderic I,et al.What is the underlying mechanism for the failure mode observed in the proximal femoral locking compression plate.A biomechanical study[J].Injury,2015,46:1483-1490.
[25]Hu SJ,Zhang SM,Yu GR.Treatment of femoral subtrochanteric fractures with proximal lateral femur locking plates[J].Acta Ortop Bras,2012,20:329-333.
[26]Sommer CH,Wullschleger M,Walliser M,et al.An experience with locking compression plate in fracture treatment of osteoporotic bones[J].Br J Surg,2004,91(7):912.
[27]Kim JW,Oh CW,Byun YS,et al.A biomechanical analysis of locking plate fixation with minimally invasive plate osteosynthesis in a subtrochanteric fracture model[J].J Trauma 2011,70:19-23.
[28]Crist BD,Khalafi A,Hazelwood SJ,et al.A biomechanical comparison of locked plate fixation with percutaneous insertion capability versus the angled blade plate in a subtrochanteric fracture gap model[J].J Orthop Trauma,2009,23:622-7.
[29]Muller ME,Allgower M,Schneider R,et al.Technique of Internal Fixation of Fractures[J].Berlin:Springer-verlag,1991.
[30]Grawe B,Le T,Williamson S,et al.Fracture fixation with two locking screws versus three nonlocking screws:a biomechanical comparison in a normal and an osteoporotic bone model[J].Bone Jt Res,2012,1:118-124.
[31]Gardner MJ,Helfet DL,Lorich DG.Has locked plating completely replaced conventional plating?[J].Am J Orthop,2004,33:439-446.
[32]Harwin SF,Stern RE,Kulick RG.Primary Bateman-Leinbach bipolar prosthetic replacement of the hip in the treatment of unstable intertrochanteric fractures in the elderly[J].Orthopedics,1990,13:1131-36.
[33]Liang YT,Tang PF,Guo YZ,et al.Clinical research of hemiprosthesis arthroplasty for the treatment of unstable intertrochanteric hip fractures in elderly patients[J].Zhonghua Yi Xue Za Zhi,2005,85:3260-62.
[34]Walia JPS,Sansanwal D,Walia SK,et al.Role of primary bipolar arthroplasty or total hip arthroplasty for the treatment of intertrochanteric fracture femur in elderly[J].Pb Journal of Orthopaedics,2011;12(1):5-9.
[35]Fan L,Dang X,Wang K.Comparison between Bipolar Hemiarthroplasty and Total Hip Arthroplasty for Unstable Intertrochanteric Fractures in Elderly Osteoporotic Patients[J].PLo S One,2012,7(6):39531.
[2]Centers for Disease Control and Prevention.Hip fractures among older adults.2014.Available at:http://www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html.
[3]Zhang K,Zhang S,Yang J,et al.Proximal femoral nail vs.dynamic hip screw in treatment of intertrochanteric fractures:a meta-analysis[J].Med Sci Monit,2014,20:1628-33.
[4]Adams CI,Robinson CM,Court-Brown CM et al.Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate of intertrochanteric fractures of the femur[J].J Orthop Trauma,2001,15:394-400.
[5]Haidukewych GJ,Israel TA,Berry DJ.Reverse obliquity fractures of the intertrochanteric region of the femur[J].J Bone Joint Surg Am,2001,83-A:643-50.
[6]Kashigar A,Vincent A,Gunton MJ,et al.Predictors of failure for cephalomedullary nailing of proximal femoral fractures[J].Bone Joint J,2014,96-B:1029-1034.
[7]Dhamangaonkar AC,Joshi D,Goregaonkar AB,et al.Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures[J].J Orthop Surg,2013,21:317-322.
[8]Abdelkhalek M,Ali AM.Cemented bipolar hemiarthroplasty with a cerclage cable technique for unstable intertrochanteric hip fractures in elderly patients[J].Eur J Orthop Traumatol,2013,23(4),443-448.
[9]Stappaerts KH,Deldycke J,Broos PL,et al.Treatment of unstable peritrochanteric fractures in elderly patients with a compression hip screw or with the Vandeputte(VDP)endoprosthesis:a prospective randomized study[J].J Orthop Trauma,1995,9(4):292-7.
[10]Lindskog DM,Baumgaertner MR.Unstable intertrochanteric hip fractures in the elderly[J].J Am Acad Orthop Surg,2004,12(3):179-90.
[11]Evans EM.The treatment of trochanteric fractures of the femur[J].J Bone Joint Surg Br,1949,31B(2):190-203.
[12]Marsh JL,Slongo TF,Agel J,et al.Fracture and dislocation classification compendium-2007:Orthopaedic Trauma Association classification,data base and outcomes committee[J].J Orthop Trauma,2007,21(10):S1-133.
[13]Boyd HB,Griffin LL.Classification and treatment of trochanteric fractures[J].Arch Surg,1949,58:853-66
[14]Kokoroghiannis C,Aktselis I,Deligeorgis A,et al.Pappadas I Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures-a review[J].Injury,2012,43(6):686-693.
[15]Socci AR,Casemyr NE,Leslie MP,et al.Implant options for the treatment of intertrochanteric fractures of the hip:rationale,evidence,and recommendations[J].Bone Joint J,2017,99-B(1):128-33.
[16]Rethnam U,Cordell-Smith J,Kumar TM,et al.Complex proximal femoral fractures in the elderly managed by reconstruction nailing-complications and outcomes:a retrospective analysis[J].J Trauma Manag Outcomes,2007,1(7):1-7.
[17]Hohendorff B,Meyer P,Menezes D,et al.Treatment results and complications after PFN osteosynthesis[J].Unfallchirurg,2005,108(11):938,940,941-46.
[18]Simmermacher RK,Ljungqvist J,Bail H,et al.The new proximal femoral nail antirotation(PFNA)in daily practice:results of a multicentre clinical study[J].Injury,2008,39:932-9.
[19]Raviraj A,Anand A,Chakravarthy M,et al.Proximal femoral nail antirotation(PFNA)for treatment of osteoporotic proximal femoral fractures[J].Eur J Orthop Surg Traumatol,2012,22:301-05.
[20]Mereddy P,Kamath S,Ramakrishnan M,et al.The AO/ASIF proximal femoral nail antirotation(PFNA):a new design for the treatment of unstable proximal femoral fractures[J].Injury,2009,40:428-32.
[21]Sahin S,Ertürer E,Oztürk I,et al.Radiographic and functional results of osteosynthesis using the proximal femoral nail antirotation(PFNA)in the treatment of unstable intertrochanteric femoral fractures[J].Acta Orthop Traumatol Turc,2010,44:127-34.
[22]Ruecker AH,Rupprecht M,Gruber M,et al.The treatment of intertrochanteric fractures:results using an intramedullary nail with integrated cephalocervical screws and linear compression[J].J Orthop Trauma,2009,1:22-30
[23]Ma CH,Tu YK,Yu SW,et al.Reverse LISS plates for unstable proximal femoral fractures[J].Injury,2010,41:827-833.
[24]Schneider K,Oh JK,Zderic I,et al.What is the underlying mechanism for the failure mode observed in the proximal femoral locking compression plate.A biomechanical study[J].Injury,2015,46:1483-1490.
[25]Hu SJ,Zhang SM,Yu GR.Treatment of femoral subtrochanteric fractures with proximal lateral femur locking plates[J].Acta Ortop Bras,2012,20:329-333.
[26]Sommer CH,Wullschleger M,Walliser M,et al.An experience with locking compression plate in fracture treatment of osteoporotic bones[J].Br J Surg,2004,91(7):912.
[27]Kim JW,Oh CW,Byun YS,et al.A biomechanical analysis of locking plate fixation with minimally invasive plate osteosynthesis in a subtrochanteric fracture model[J].J Trauma 2011,70:19-23.
[28]Crist BD,Khalafi A,Hazelwood SJ,et al.A biomechanical comparison of locked plate fixation with percutaneous insertion capability versus the angled blade plate in a subtrochanteric fracture gap model[J].J Orthop Trauma,2009,23:622-7.
[29]Muller ME,Allgower M,Schneider R,et al.Technique of Internal Fixation of Fractures[J].Berlin:Springer-verlag,1991.
[30]Grawe B,Le T,Williamson S,et al.Fracture fixation with two locking screws versus three nonlocking screws:a biomechanical comparison in a normal and an osteoporotic bone model[J].Bone Jt Res,2012,1:118-124.
[31]Gardner MJ,Helfet DL,Lorich DG.Has locked plating completely replaced conventional plating?[J].Am J Orthop,2004,33:439-446.
[32]Harwin SF,Stern RE,Kulick RG.Primary Bateman-Leinbach bipolar prosthetic replacement of the hip in the treatment of unstable intertrochanteric fractures in the elderly[J].Orthopedics,1990,13:1131-36.
[33]Liang YT,Tang PF,Guo YZ,et al.Clinical research of hemiprosthesis arthroplasty for the treatment of unstable intertrochanteric hip fractures in elderly patients[J].Zhonghua Yi Xue Za Zhi,2005,85:3260-62.
[34]Walia JPS,Sansanwal D,Walia SK,et al.Role of primary bipolar arthroplasty or total hip arthroplasty for the treatment of intertrochanteric fracture femur in elderly[J].Pb Journal of Orthopaedics,2011;12(1):5-9.
[35]Fan L,Dang X,Wang K.Comparison between Bipolar Hemiarthroplasty and Total Hip Arthroplasty for Unstable Intertrochanteric Fractures in Elderly Osteoporotic Patients[J].PLo S One,2012,7(6):39531.