带蒂肌骨瓣治疗错位型青壮年股骨颈骨折

Pedicled Muscle and Bone Flap for Treatment of Malpositioned Femoral Neck Fracture in Young Adults

目的总结三种带蒂肌骨瓣治疗青壮年错位型股骨颈骨折的疗效. 方法回顾性分析采用3种带蒂肌骨瓣治疗的42例错位型青壮年股骨颈骨折的临床资料,其中GardenⅢ型32例,Ⅳ型10例. 结果本组后方入路行股方肌骨瓣移植14例,前方入路行缝匠肌骨瓣移植12例,骨外侧肌骨瓣移植16例.42例均获随访,平均31/12年(8个月～9年).骨折愈合时间平均6(3～11)个月.1例骨折延迟愈合,2例骨折不愈合,骨折愈合率为95.2%(40/42).股骨头缺血坏死5例(11.9%),其中2例为骨折不愈合者,3例于股骨颈骨折愈合1年后发生. 结论带蒂肌骨瓣移植加多根松质骨加压螺钉内固定治疗青壮年GardenⅢ型、Ⅳ型股骨颈骨折,对提高青壮年错位型股骨颈骨折愈合率和降低股骨头缺血坏死率疗效肯定,手术经验提示前方入路带蒂肌骨瓣移植的效果似优于后方入路.

Objective To analyze the therapeutic effect of three variety of pedicled muscle and bone flap treating malpositioned femoral neck fracture in young adults. Method 42 young adults of malpositioned femoral neck fracture underwent surgery with 3 variety of pedicled muscle and bone flap, including Garden Ⅲ in 32 cases, Garden Ⅳ in 10 cases. Result Operation performed via posterior approach with quadrate muscle flap in 14 cases, anterior approach with sartorius muscle flap in 12 cases, and vastus lateralis flap in 16 cases. Average follow-up was 31/12 years (8 months～9 years) in all cases. Average fracture healing duration was 6(3～11)months with a fracture union rate of 95.2%(40/42), nonunion occured in 2 cases and delayed union in 1 cases. Femoral head necrosis occured in 5 cases (11.9%), including 2 cases of nonunion and 3 cases occurence as late as 1 year after healing. Conclusion Pedicled muscle and bone flap associated with multiple matrix compressing screws fixation can contribute to improve the healing rate of Garden Ⅲ and Ⅳ malpositioned femoral head fracture in yound adults and reduce femoral head necrosis. Operative experience indicates the anterior approach is superior to posterior approach.