选择适宜的金属植入物内固定治疗股骨近端骨折

摘要

背景：股骨近端骨折好发于老年人群，治疗时选择适宜的内固定植入物是保证生物相容性以及效果的关键。目的：分析股骨近端骨折内固定金属植入物的选择以及生物相容性。方法：由第一作者于2012年12月应用计算机检索国内外数据库相关文章，中文检索词为“股骨近端骨折，动力髋螺钉，微创固定系统，经皮加压钢板，Gamma 钉，髓内钉”，英文检索词为“proximal femoral fracture，dynamic hip screw，less invasive stabilization system，percutaneous compression plate， Gamma nail”，并限定文章语言种类为中文和英文。共检索到相关文献142篇，符合纳入标准并用于分析的文献17篇。结果与结论：①股骨近端骨折的治疗方法有几种，包括保守治疗、金属植入物内固定治疗、外固定支架固定、锁定钢板以及人工假体置换治疗等。目前国内外的治疗观点已摒弃牵引等保守治疗方法，尽量行金属植入物内固定。②临床金属植入物内固定的选择主要分为髓外固定装置和髓内固定装置，髓外固定装置包括动力髋螺钉、经皮加压钢板、股骨远端倒置微创固定系统，髓内固定装置包括股骨近端髓内钉、Gamma 钉、重建钉等。③每种治疗方法和植入物内固定装置都有其各自的优点及局限，临床治疗中要根据患者病情和治疗需要提出个性化的治疗方案，选择适宜的方法。%BACKGROUND: Proximal femoral fracture often occurs in elderly population, and selecting the appropriate fixation implants is the key to guarantee the biocompatibility and treatment effect. OBJECTIVE: To analyze the selection and the biocompatibility of the metal implants for internal fixation for the treatment of proximal femoral fracture. METHODS: The relative databases at home and abroad were searched by the first author for the relative articles in December 2012. The Chinese key words were “proximal femoral fracture, dynamic hip screw, less invasive stabilization system, percutaneous compression plate, Gamma nail, intramedul ary nail”, and the English key words were “proximal femoral fracture, dynamic hip screw, less invasive stabilization system, percutaneous compression plate, Gamma nail”. The literatures of the articles were Chinese and English. A total of 142 articles were screened out, and 17 articles were included for the final analysis according to the inclusion criteria. RESULTS AND CONCLUSION: The methods for the treatment of proximal femoral fracture included conservative treatment, metal implants internal fixation, external fixation, locking plate and prosthesis replacement therapy. At present, the domestic and international treatment points have abandoned the conservative treatments such as traction, and try best to perform the metal implants internal fixation. The clinical metal implants internal fixation can be divided into extramedul ary fixation device and intramedul ary fixation device, and the extramedul ary fixation device included dynamic hip screw, inverted distal femoral less invasive stabilization system and percutaneous compression plate, while the intramedul ary fixation device included the proximal femoral intramedul ary nail, Gamma nail and reconstruction nail. Each treatment method and internal fixation device has their own advantages and limitations. We should propose a personalized treatment program and select the appropriate method according to the patient’s condition and treatment requirement during the clinical treatment.