遵从性级别的花园和AO分类为股骨颈骨折

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在世界的各个部分由于增加了人类的生存。而在老年人,他们低能创伤及其相关治疗通过在流离失所的骨折关节成形术或固定在那些没有偏差;在年轻患者中,场景是不同的,由于高能创伤和通常先发生车祸相关或从高处跌落。先的风险因素包括:女性、低骨质密度,降低流动性。骨折的风险显著增加3岁。先,股骨头血管化的风险。最接受的原因这缺血会破裂或扭转Weitbrecht支持带,其中包含2到4升retinacula子滑膜血管,分支的股骨内侧动脉和滋养超级侧股骨头的一部分,最重要的区域股骨头力学的观点。股骨颈的另一大特点,在其intracapsular部分,是它没有骨膜层,使骨折合并一个主要过程,最后偷类型。出于这个原因,绝对稳定是必需的。滑液的存在,从而防止血栓的形成,是重要的因素。 The knowledge of this mechanism is important for a correct diagnosis, which depends on a thorough physical examination and on obtaining radiographs of the pelvis in anteroposterior (AP), of the affected hip in antero posterior and lateral views. In deviated fractures, an anteroposterior radiograph with mild traction and medial rotation can help in interpreting the fracture line. Profile radiography can change Garden's classification in up to 80% of cases, due to the detection of deviations not visible in the frontal image. It is important to include an X-ray of the entire femur due to the possibility of associated injuries. Computed axial tomography can help identify cervical fragmentation, especially in its posterior portion, a recognized sign of poor prognosis. In cases of suspected occult fracture or associated pathological lesions, magnetic resonance imaging is more useful, being the gold standard exam due to its greater sensitivity to detect stress fractures, incomplete or without displacement, even in early stages. The treatment of this important fracture has evolved over time. In 1820, Sir Ashley Cooper already believed that FCF pseudarthrosis was inevitable due to damage to the vascularization of the femoral head. Thirty years later, this scenario began to change, when Langenbeck described fixation using screws introduced through the femoral neck. In 1935, Frederic Pauwels shed light on the main mechanical problems involved in this type of fracture, showing that, according to the inclination of the fracture line, the resulting force could be either compression or shear. In 1961, Robert Symon Garden described a more comprehensive classification, which incorporates displacement, fracture integrity and relationship of bone trabecular in the head and neck of the femur. These findings were important so that the appropriate means of treatment were studied and could return the individual to previous levels of function; achieve the reduction anatomical to preserve the blood supply; and, provide a stable fixation, with bone preservation, to achieve consolidation. In elderly people with low-energy fractures, there is a consensus that non-displaced or incomplete fractures impacted in valgus should be fixed, while displaced fractures should be treated with hip arthroplasty. In young people, arthroplasty is not desirable as the first form of treatment due to the high demand and young age, as it can lead to high rates of revision in the long term. Most authors agree that fractures without displacement (Garden I or II) can be approached and fixed percutaneous. On the other hand, in displaced fractures (Garden III and IV), advocates of the open approach believe that anatomical reduction can only be achieved reliably and reproducibly through direct visualization. In this option, surgical access also allows the use of a more stable fixation, in addition to, obviously, decompressing the intracapsular hematoma. Garden’s Alignment Index (Figure 1) is used to verify the quality of the reduction in 2 orthogonal, anteroposterior and lateral views. In case of failure to obtain the reduction by closed means, the anatomical reduction in open air is mandatory.

有4个植入选项:cannulised螺丝、滑针板(DHS)型,固定角锁板或全髋关节假体关节成形术。在花园I或II骨折,没有结果的差异使用螺丝或滑针板设备,在使用或不使用anti-rotational螺钉。在不稳定和倾斜骨折Pauwels II或III,花园III或IV,无论是平行螺丝还是滑动plate-pin设备与anti-rotational螺丝还是锁着的盘子都没有好的结果在这些骨折的固定。与cannulised螺丝固定,螺丝横向断裂站点可以使用。这种方法类似于固定方法所描述的花园在过去。提出的技术使用一个入支撑板,可以通过猎人的前安装方法和作为一个强大的异型边撑。这个盘子必须结合螺丝或针板和显示一个与传统方法相比,抗剪强度增加80%。然而,对于正确的治疗,这是非常重要的,外科医生的知识先分类,这具有重要的临床意义,因为它通常用于显示足够的治疗。的主要分类先暂停,花园,其毛皮Osteosynthesefragen (AO)分类。在这项研究中,我们将只关注花园和AO。 Garden's classification is the most popular and most used in clinical practice and is based on the X-ray of the pelvis in the anteroposterior view, determining the stages or degrees of displacement between the fragments according to the alignment of the primary compressive trabecular of the cervix with the trabecular of the acetabulum. It is an evolutionary classification that describes the stages of sequential deviation of the fragments. Garden evaluated 80 patients with FCF, which he classified into types I to IV, and followed these patients for at least 12 months postoperatively. He found that type I and II fractures had a 100% healing rate. While types III and IV had lower union rates of 93% and 57%, respectively.

花园的四种类型/阶段描述如下:阶段我不完整的子资本骨折。骨折的内皮层出现在“绿色棒”,和最小偏差创建嵌入的假象。远端片段略绑架,外部旋转;阶段II完全子资本骨折没有位移。下皮层有一个完整的裂缝,但没有股骨头的测角;第三阶段完成子资本骨折局部位移。2在一起的片段Weitbrecht韧带。没有后皮质的碎片。头部与髋臼,相对于广播逻辑证明的内侧骨片晶的不同方向(抗压)的关系的髋臼;四期完成子资本与总位移骨折。 Acetabula trabecular aligned with the compressive trabecular of the cervix; neck is shortened. The retinaculum is broken and the 2 fragments are completely independent. The head returns to its natural position and, radio logically, its medial bony lamellae align with those of the acetabulum

成绩我在花园的分类,第二和第三可能完整的血管化;等级I和II是稳定的,而第三和第四的成绩不稳定。低国际花园和intraobserver协议的分类使它更有用的老年人口,直接治疗,它被简化成2模式:non-deviated - I和II花园;倾斜——花园III和IV。

AO分类最近被修改,使它更简单、更多功能。在变化中,术语“多分裂”已经取代了复杂的,因为它是更有用的和精确的。介绍了可选的“普遍修饰符”,它可以被使用,在方括号中,描述形态、偏差、相关病变或位置。可选“限定词”介绍了,具体到每个骨折,可用于括号。骨头编号在一个标准化的方式,包括胸部。股骨是被数字3,用数字1的编码位置的近端部分。骨折之间的一条线画在慢跑的远端边缘股骨头软骨和转子间骨折线分为先或子资本和被认为是类型B21