Femoral neck fracture hi clinical practice-a orthopedic injury tawn tam ber zinga mi a ni a, kum upa lam tam zawk chuan hip fracture 50% aia tam an nei a ni. Statistics-a a lan dan chuan tun hnaiah femoral neck fractures vei an pung zauh zauh a, mipa aiin hmeichhia an tam zawk. Tlangvalte zingah vertigo, dementia, malignancy leh cardiopulmonary disease te hi thalai te zingah chuan femoral neck fractures te hi high-risk factors an ni.
Tun hnaiah internal fixation material tam tak, hollow screws, power hip screw (DHs), sliding hip screws (HSH), proximal femoral dissection plate, reconstruction nail, leh gamma nail te a lo chhuak a. Heng internal fixation materials zingah hian hollow screw hman tam ber a ni. Zirna hrang hrangah chuan surgeon tam zawk chuan nondisplaced fracture enkawlna atan hollow screw an duh zawk tih hmuhchhuah a ni a, surgeon tam zawk chuan displaced femoral neck fractures atan hollow screw hman an thlang zawk a ni. 3 Parallel partially threaded hollow screw fixation hi internal fixation tih dan pawm zawk a ni.
Femoral neck fractures a taksa peng hrang hrang awm dan .
Tunah chuan femoral head-a vascular structure hi fracture healing leh femoral head necrosis nghawngtu pawimawh ber a ni tih pawm tlangpui a ni. Femoral head thisen supply structures tihchhiat hi femoral head ischemic necrosis pathological factor ber a ni. Femoral neck-a vascular anatomy systematic study chuan epiphyseal vascular network leh inferior supporting zone-a arterial system chu femoral neck fracture hnua femoral head-a thisen supply vawn rengna tur structure pawimawh tak a ni thei tih a hmuchhuak a, chutiang chuan intraoperative drilling leh implanation chu femoral head-a central-a awm theihna, a theih ang anga a theih ang anga a theih ang anga a hnaih theih ang bera a awm theihna tur a ni a, chu chu vas drilling leh implanation a ni thei a, chu chu central-a infiamna a ni thei a, chu chu a tha ber a ni. tihdan.
![A rilru a buai em em a.]()
Figure 1 Femoral lu, anterolateral (A) leh posterior (B) views-a thisen supply. Femoral head-a thisen supply-ah hian danglamna a awm a, mahse lateral leh medial spinofemoral artery te hi damlo 60%-ah chuan deep femoral artery atanga lo chhuak a ni.
(1) Femoral head-a thisen supply tam zawk hi lateral rotor femoral artery atanga lo chhuak a ni.
(2) Strap artery thlawptu branch 3 emaw 4 emaw a pe chhuak thin. Heng branch te hi a hnung lamah leh chunglam hawiin retroflexed portion of the synovial neck of the femur ah chuan femoral head cartilaginous edge ah an kal thin. round ligament chhunga lawngte chu an awm.
(3) foramen occulta artery atanga lak chhuah a ni. Medial rotor femoral artery-a branch sang chho zel.
(4) chuan femur trochanter lian zawk a supply a, lateral rotor femoral artery hmangin arterial ring a siam bawk.
Femoral neck fracture atan hollow screw a awm bawk.
Clinically chuan hollow cancellous bone screw pathum 6.5 mm emaw 7.0 mm emaw 7.3 mm emaw hmangin damlo naupang zawkte emaw, kum chanve emaw kum upa zawk, ruh quality tha tak nei te tan fixation atan hman theih a ni. Sliding fracture compression awm theihna turin hollow nail 3 te chu parallel-a dah turin guide hman tur a ni. Femoral neck chhungah chuan screw te chu a sir zawng zawngah screw in tur a ni a, screw te chu femoral head chhungah thread a nih leh nih loh ngaihtuah la, fracture line atanga across a nih loh nan, hei chauh hi inter-end compression hmuh theihna kawng a nih avangin. Screw te chu khauh taka tihkhauh a, intraoperative-a tih nawn fo tur a ni. Traction bed hman a nih chuan traction chu relax a ngai a ni. Hollow screw pawh percutaneous-in a dah theih bawk. Screw te hian hip joint an luh loh nan frontal, lateral, leh 45° oblique fluoroscopy tih a ngai a ni.
1、surgical hnathawh dan tur bik.
Clinical practice-a hman tlanglawn 'inverted triangle' nail placement kha han la ila, entirnan.
ani. A hmasa berah chuan fluoroscopy hnuaiah chuan x-ray hmangin fluoroscopy plane pahnih hmangin lower leh middle guide pins layout chu hriat theih a ni.
b. Skin incision siam a ni a, chu chu proximal-in 2-3 cm a zau a ni.
c. Fascial layer chu incision zawhin a inthen a, cobb separator hmangin lateral femoral muscle-a longitudinal fibers te chu a then hrang a ni.
d. Guide needle chu plane pahnih a famkimna hmunah dah rawh.
e. Guide pin pakhat chu anterior tilt angle hriat theihna turin femoral neck hmalam assistant hmangin anterior aspect zawh zawngin an dah a.
f. Guide pin hmasa ber fixation hnuah posterosuperior leh anterosuperior guide pin te chu femoral neck chhunga posterior leh anterior cortical support hmuh theih nan parallel guide hmangin an hmuchhuak a.
g. Hei hi femoral spine hmanga distal femoral neck cortex zawh zawnga lesser trochanter chungah guide pin dahin an ti a A hnuaia guide pin pahnih hi a hnaih thei ang bera, a theih ang anga hla leh a hma lam leh a hnung lam cortex atanga 5 mm-a hlaah dah a ni a Chumi hnuah chuan guide pin-a a luh theihna thukzia chu cartilage hnuai lam 5 mm-a hniam turin an siamrem a; A tawpah chuan a hole chu ream a ni a, teh a ni a, pressurized hollow screw chu screw in a ni.
h. Lesser trochanter hnuaia needle-ah lut lo la, femoral spine-ah proximal-in travel-in dah rawh.
Ka. Threaded guide pin chu joint hnuaiah dah tur a ni.
J. 10 a ni. Guide pin chu articular surface-ah a lut lo turin phal suh.
k. Guide pin sei zawng tehna hmangin screw sei tur dik tak chu teh la, chutah chuan 5 mm la chhuak rawh.
L. 10 a ni. A tlangpuiin self-tapping, self-drilling screw hman a ni a, mahse a chang chuan ruh thim tak nei loyal patient-ah chuan lateral cortex pre-drilling a ngai thin.
m. Space permit a nih chuan spacer hman theih a ni.
n. Kut hnunglam aspect-a comminuted fracture na tak nei loyalists te tan 4th screw (Diamond arrangement) a ngai thei.
![A rilru a buai em em a, a rilru a hah em em bawk a.]()
Tunah chuan femoral neck fractures atana hollow screw hi a tam hle tawh nachungin, surgically placed hollow screw awm zat leh configuration chungchangah ngaihdan inang lo tak tak a la awm a, a tlangpuiin operator duh dan azirin Damlo ruh density, screw strength, leh enkawlna hlawhtlinna te hian nghawng a nei bawk.
1、a hollow screw awm zat.
Femoral neck fractures hi a tlangpuiin hollow screw 2-4 hmangin an fix thin.
A tam zawkah chuan screw 3 hman a nih chhan chu anterior stress chak tak a tuar thei a, stability a tisang thei a, fracture end a displacement a ti tlem thei bawk.
Femoral neck fractures pauwells angle >50° nei tan chuan screw 2 a tlem zawk.
Posterior femoral neck-a comminuted fracture na tak tak nei damlote tan chuan hollow screw 4 an rawt a ni.
Mahse, hmanlai practice chu fixation atan hollow screw 3 hman a la ni.
2、Allow screw hmanga siam a ni.
Femoral neck fracture chhunga fixation atana hollow screw 3 hman a nih chuan 'sliding compression' theory chu zawm tur a ni tih an ring tlangpui a, chutiang chuan screw 3 dah chu orthogonal view-ah chuan a inmil a, lateral view-ah triangular configuration a nei a ni.
Chutiang chuan parallel hollow screw pathumte chuan mechanical support tha tak a pe thei a, sliding track a siam thei a, chutiang chuan fracture block chu hip muscles inzawmna hnuaiah femoral neck axis-ah a tlan thei a, fracture tawp lamah pressure a siam a, fracture damna a tichak thei bawk.
Mahse, hollow screw 3 te hi orthotriangular emaw inverted triangular configuration-a dah a nih leh nih loh chu sawisel a hlawh hle.
Hollow screw fixation technique lama hmasawnna te chu femoral neck fractures te tan a ni.
Yuenyongviwat leh a thawhpuiten an zirchiannaah chuan, “S. Designed a new adjustable parallel drilling guide for the placement of the placement of hollow screws in the treatment of femoral neck fractures by internal fixation, leh he guide thar hian operation hun leh intraoperative fluoroscopic views awm zat chu traditional method nena khaikhin chuan a tihtlem thei tih a hmuchhuak a, chu chuan surgical results satisfactory tak a hmu thei a ni.
Filipov leh a thawhpuiten an zirchiannaah chuan, Designed a biplane double-supported screw fixation (BDSF), chutah chuan hollow screw pathum entry point chu proximal femoral stem-a cortical area thick takah a awm a, screw pathumte chu femoral head periphery-ah a inang tlang vek a, chu chuan plane pahnih a siam a ni. Hetiang approach hian double cortical support a phalsak a, chu chuan movement laiin fixation strength tling tak a pe thei a ni.
Cadaveric specimen hmanga biomechanical experiment an neihah chuan BDSF fixation method hian traditional inverted triangle fixation method aiin fixation tha zawk a pe tih hmuhchhuah a ni. Cadaveric specimen hmanga biomechanical experiment result atanga a lan dan chuan calcium phosphate cement reinforced hollow screw fixation hian hollow screw fixation of femoral neck fractures stability nasa takin a ti tha a, femoral neck compression resistance a ti sang a, torsional stiffness a ti tha a, hei hi clinical value nasa tak a ni.
Femoral neck fractures atana hollow nail fixation hnua femoral head necrosis awm theihna sang tak a awm avangin, femoral head necrosis ang chi harsatna tihziaawmna turin hollow nail internal fixation pui turin kawng dang hman chhunzawm zel a ni. Femoral neck fracture hnua femoral head necrosis awm chhan bulpui ber chu femoral head-a thisen kal a hloh vang a ni a, chuvangin enkawlna ngaih pawimawh ber chu thisen kal dan tur a ni. Blood-supplied periosteum graft chu femoral head necrotic area-ah dah luh a nih chuan leh germinating layer-in residual cavity pawn lam a luah khat chuan grafted periosteum chu osteoblast-a inthlak danglamna a siam thei ang a, chubakah vascular sprouts siam thar lehna tur a ni bawk ang, chu chuan osteogenicizing effect a nei bawk.
Khaihtawi
Hollow screw fixation for femoral neck fracture hi fixation method tha tak a ni a, chu chuan simple operation, short operation time, trauma tlem, fixation rintlak leh postoperative recovery chak tak a neih thatna a nei a ni. Mahse, femoral neck fractures anatomical characteristics avang hian femoral head ischemic necrosis leh femoral neck fractures te internal fixation hmang hian non-union a awm loh chuan a buaithlak thei lo. Chuvangin, he fixation method hman dan tur indication te hi hman hmain chiang zawka hriat a ngai a, leh tar chak taka femoral neck fractures displaced leh general status nei tha lo, early activity mamawhna nei te chuan a theih ang anga femoral neck fractures internal fixation hman loh tur a ni. Damlo prognosis nghawng thei risk factors, fracture chi hrang hrang, ruh density, leh damlo functional status te pawh ngaihtuah tel a, hun rei tak hnua postoperative complication tihziaawmna tur leh chutiang chuan femoral neck fractures enkawlna outcome tihchangtlun nan.
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