我个人一直认为动力髋+一枚空心钉是最稳定的固定方式，这个观点不一定对，前期我做过很多这类手术，基本上都愈合了，坏死率没有明显降低，现在动力髋已经找不到了，国外还有，下面是国外教授的观点，供大家参考吧。
Displaced femoral neck fracture in a healthy 53 yr old patient. Don’t forget a simple DHS.
First debate: total hip arthroplasty vs femoral neck fixation:Fixation has a 30% risk of failure (eg non-union, AVN). However, that means 70% risk of success! Arthroplasty isn’t without complications: infection, dislocation, need for revision etc. I’m honest with my patients and give them the risks and benefits of both. You should always discuss with the patient to see how they want to proceed, but I know if I was in my 50s I would want to keep my own femoral neck.
Next debate, type of fixation:I see many new devices and techniques, but for me, a simple DHS done well has be best track record. I typically use a cannulated screw proximally as a de-rotation screw, so the neck doesn’t sheer off when inserting the screw. Then I compress with the DHS. DHS is biomechanically much stronger than 3 cannulated screws. Proximal femoral plates have high rates of failure. The FNS system is new and there are multiple reports of subtrochanteric fractures. Unless there is strong evidence for another device, I will stick to the simple DHS that has lated the test of time. Lastly, you should never use a cephalomedullary nail for a femoral neck fracture. .Next debate, open vs closed reduction:There is multiple recent studies demonstrating that open reduction does not improve outcomes, and has complications. If you can achieve adequate reduction closed, that’s better than opening the fracture to get a 100% perfect reduction. Open reduction to achieve a perfect reduction is not worth the negative consequences of the open approach.
This was done with a closed reduction. Its not perfect, but it’s well acceptable. This is a 2 hole DHS, 135 degrees. Cannulated screw first to maintain reduction, then the DHS. Always tap before inserting the lag screw, use the compression screw to compress the fracture. Patient will be touch weightbearing post-op for 6 weeks, then WBAT. He will be monitored for signs of AVN and failure.
