中青年陈旧性股骨颈骨折的股骨颈重建

TREATMENT OF OLD FEMORAL NECK FRACTURE IN YOUNG AND MIDDLE-AGED PATIENTS WITH RECONSTRUCTING FEMORAL NECK

目的为中青年陈旧性股骨颈骨折寻求保留自身髋关节的理想治疗方法。方法2002年1月-2006年6月,对28例中青年陈旧性股骨颈骨折采用游离髂骨瓣重建股骨颈、空心加压螺钉和/或短柄动力髋螺钉内固定术治疗,其中19例联合旋股外侧血管束植入治疗。男23例,女5例;年龄19～55岁,平均37.6岁。均为闭合性骨折,左髋17例,右髋11例。骨折部位分型:头下型4例,经颈型17例,基底型7例。术前Harris评分为25～72分,平均49.6分。所有患者经X线检查未见骨痂生长;4例有股骨头硬化囊性变,经MRI检查证实为股骨头缺血性坏死。受伤至该次手术时间为1～21个月,平均8.6个月。结果28例均未发生伤口感染,5例患者出现股前外侧皮神经麻木,未予特殊处理,随访6个月好转。28例均获随访,随访时间20～72个月,平均35.8个月。25例术后4～8个月骨折愈合,愈合率为89.3%;3例骨折不愈合,行人工全髋关节置换。随访18个月内7例经MRI检查示股骨头缺血性坏死,发生率为25%。随访期间5例出现股骨头晚期塌陷,发生率为17.9%。术后Harris评分为27～100分,平均82.7分。肢体无明显短缩,步态基本正常。结论股骨颈重建术能恢复股骨头颈的大致正常解剖关系和股骨头的血运,促进骨折愈合,延缓或避免人工全髋关节置换,是中青年陈旧性股骨颈骨折保留自体髋关节的一种治疗方法。

Objective To explore fracture in young and middle-aged patients an ideal operative treatment to preserve the hip joint for the old femoral neck Methods Between January 2002 and June 2006, 28 cases of old femoral neck fracture, 23 males and 5 females, aged 1%55 years old （37.6 on average）, were reconstructed with free iliac grafts and fixed by dynamic hip screws （DHS） and/or canulated screws. Multiple vascular bundles derived from lateral circumflex femoral vascular were implanted in 19 cases. MI the 28 cases were close fractures, with 17 of left hip and 11 of right hip. In terms of the fracture site, 4 cases were infer-head, 17 were per-neck and 7 were fundamental-form. The Harris score was 25-72 （49.6 on average） before operation. No callus formation was found on X-ray films in all cases; sclerosis and cyst were found in 4 cases and osteonecrosis of femoral head （ONFH） was confirmed by MR/. The duration between initial injury and surgery was 1-21 months （8.6 months on average）. Results No deep infection was observed in all 28 cases, and paralysis of the lateral cutaneous nerve of the thigh was observed in 5 cases, and was better 6 months after operation with no special treatment. M1 28 cases were followed up for 20-72 months （35.8 months on average）. A total of 25 fractures healed within 4-8 months, with the healing rate of 89.3%; 3 fractures had nonunion and received artificial hip replacement. During the follow-up, 7 cases （25%） developed ONFH confirmed by MRI within 18 months, and 5 cases （17.9%） developed femoral head collapse. The Harris score was 27-100 （82.7 on average）. Leg length discrepancy was not observed and the gait was fairly normal. Conclusion The femoral neck reconstruction procedure can restore the normal anatomy of femoral head and neck and the blood supply, so as to promote fracture healing as well as delay or avoid the artificial joint replacement. Therefore, it is an important treatment to preserve the hi p joint for the old femoral neck fracture in young and middle-aged patients.