Views: 2 Author: Site Editor Publish Time: 2022-09-28 Origin: Site
At present, it is generally believed that hollow nail internal fixation for femoral neck fracture has the advantages of short operation time, little trauma and low cost, but most elderly patients are accompanied by osteoporosis, so the stability of internal fixation should be fully considered. For unstable femoral neck fracture patients, they need to stay in bed for a long time, and many scholars think that they can't bear weight early, which seriously affects the quality of life of patients. In addition, there are the possibility of fracture nonunion and femoral head necrosis.Hip replacement can completely solve the main problems of femoral neck fracture nonunion and avascular necrosis of femoral head in elderly patients, and can avoid complications such as pressure sore, respiratory infection and urinary infection as much as possible.
The long-term complications of patients with femoral neck internal fixation are mainly nonunion and avascular necrosis of femoral head. Some scholars believe that weight-bearing activities in the middle and early stage have the greatest influence on the postoperative femoral neck fracture, and staying in bed for a long time after operation can reduce the stimulation to the fracture end and provide a more stable environment for the smooth healing of the fracture. Early accurate reduction, reliable internal fixation, reduction of local blood supply destruction and improvement of local blood perfusion can effectively reduce the occurrence of avascular necrosis of femoral head after femoral neck fracture.
Preoperative traction has always been controversial. Its main purpose is to relieve pain, reduce the movement of the affected limb, and reduce the possibility of displacement or aggravation of displacement at the fracture end. However, some people think that unreasonable traction will lead to the increase of joint capsule pressure, and then affect the blood supply around the femoral head, that is, "stuffing effect", thus increasing the incidence of avascular necrosis of the femoral head.
Studies have shown that the femoral head necrosis rate is 27.8% in those without over-traction and 42% in those with over-traction. In addition, some studies have shown that keeping the affected limb in the rotational neutral position of 30 flexion of hip joint, 30 flexion of knee joint and 10 abduction during traction can reduce the pressure in hip joint cavity and increase the blood supply of femoral head. For this reason, there are clinical reports that the tibial tuberosity traction is continued for 3 weeks after hollow nail fixation, and the traction weight is 1.5kg, so as to keep the affected limb in the rotational neutral position of 30 flexion of hip joint, 30 flexion of knee joint and 10 abduction.
Total hip replacement is a surgical method that uses artificial prosthesis to replace the damaged total hip tissue, which effectively solves the problems of femoral neck fracture in the elderly, such as fracture nonunion and femoral head necrosis caused by blood supply disturbance and osteoporosis. However, because of the complicated operation process, long operation time and large surgical trauma, the operation risk to the elderly patients is high, and there is a certain joint dislocation rate after operation.
Artificial femoral head replacement can effectively reduce the surgical trauma and shorten the postoperative rehabilitation time of patients, but there are some problems such as acetabular wear in the long term, which will affect the postoperative hip function of patients.
Elderly patients are often complicated with osteoporosis, so there is still some controversy about whether to choose bone cement femoral prosthesis or biological femoral prosthesis.
Bone cement can provide a good bite force in the early stage, and can adapt to the femoral medullary cavity with poor bone, so that the elderly patients can recover the hip joint function earlier and reduce the occurrence of other systemic complications. However, it has also been reported that bone cement implantation syndrome may occur during the operation of bone cement prosthesis, resulting in high mortality during and after operation, especially in patients with cardiopulmonary dysfunction before operation, and long-term revision is more difficult.
Biological prosthesis can avoid bone cement implantation syndrome and shorten the operation time. However, biological femoral prosthesis requires that the prosthesis handle should be well matched with the metaphysis and medullary cavity of femoral shaft, otherwise it will lead to the loosening and sinking of the prosthesis in the near future or in the long term, especially Dorr C chimney femoral medullary cavity, which is prone to complications such as periprosthetic fracture and instability during and after operation.
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