腓骨联合髂骨移植治疗陈旧性股骨颈骨折

FREE VASCULARIZED FIBULAR ASSOCIATED WITH ILIAC GRAFT TO TREAT OLD FEMORAL NECK FRACTURE

目的对陈旧性股骨颈骨折行吻合血管腓骨部分联合髂骨移植治疗,并观察临床效果。方法1994年1月-1997年1月,收治76例陈旧性股骨颈骨折患者。男54例,女22例;年龄24～48岁,平均31.5岁。骨折均为外伤所致。根据Garden分型:Ⅱ型20例,Ⅲ型41例,Ⅳ型15例。骨折部位:头下型26例,经颈型42例,基底型8例。伤后曾行内固定治疗者65例,皮牵引治疗者7例,单纯卧床者4例。Harris评分52～72分,平均65.6分。受伤至该次手术时间2～24个月。术中采用6～8cm带血管蒂腓骨移植加单侧外固定支架固定骨折,对股骨颈缺损超过5mm者联合3.0cm×2.0cm×1.5cm的带旋髂深动静脉蒂的髂骨瓣移植。结果术后68例获随访,骨折愈合时间4～6个月,平均5.2个月。其中5例因股骨头坏死或髋关节脱位行人工全髋关节置换术;余63例获随访10.1～12.4年,平均10.5年。63例髋关节活动恢复正常。随访10年Harris评分84～94分,平均87.5分。X线片示患者股骨头在术后1年骨密度均增高;术后10年股骨头结构基本正常,植入腓骨和髂骨与股骨头颈部完全融合,无囊变及骨塌陷。结论对选择保留股骨颈的陈旧性股骨颈骨折患者,吻合血管腓骨联合髂骨移植是一种较好的方法。

Objective To evaluate the clinical outcome of free vasctilarized fibulat associated with iliac graft in treatment of old femoral neck fracture. Methods From January 1994 to January 1997, 76 cases of old femoral neck fracture were treated with free vascularized fibular associated with iliac graft, including 54 males and 22 females, aging from 24 to 48 years with an average of 31.5 years. All of these fractures resulted from injury. There were 20 cases of Garden Ⅱ, 41 of Garden Ⅲ and 15 of Garden Ⅳ. Based on the location of fracture, there was 26 cases of subcapital, 42 cases of transcervical and 8 cases of basal. Sixty-five cases were treated with internal fixation, 7 cases with skin traction and 4 just with staying in bed. Their Harris score were from 52 to 72 with an average of 65.6. The time from injury to operation was 2-24 months. The size of free vascularized fibular was 6-8 cm and iliac graft was 3.0 cm×2.0 cm× 1.5 cm. Results In 76 cases, 68 were followed up and all fractures healed within 4 to 6 months with an average of 5.2 months. The increased density in femoral head was observed 1 year after operation. After 10 years of operation, normal hip function was achieved in 63 cases foUowed up 10.1 -12.4 years with the average as 10.5 years）; the Harris score was 87.5 （84 to 94）. The structure of femoral head was normal and the grafted fibular and il iac bone healed with the femoral, no elapse or cyst occurred. Five cases had been complied with total hip replacement for femoral head necrosis or other. Conclusion Free vascularized fibular associated with iliac graft is a good method to treat old femoral neck fracture.