股骨头骨折后并发股骨头缺血性坏死的治疗

Treatment of femoral head of patients with osteonecrosis of the femoral head fracture

目的探讨股骨头骨折内固定术后并发股骨头缺血性坏死的治疗。方法对单侧股骨头骨折内固定术后股骨头缺血性坏死采用带血运骨瓣转移术治疗的26例临床资料进行回顾分析。21例数字减影血管造影（DSA）检查明确股骨头及其周围骨的血供后行内固定物取出、带血运骨瓣转移术。1例内固定物取出后行全髋置换术。结果施行带血运骨瓣转移术的术后平均随访23个月（12～38个月），根据Harris髋关节功能评分标准进行临床评价，根据手术前后Ficat分期改变进行影像学评价。对其中15例进行术后DSA检查以明确坏死股骨头血运重建情况。术后2髋改行人工全髋关节置换。股骨头得到重建的病例，术后Harris髋关节功能评分提高至平均86．2分（术前平均54分），其中临床成功率为92．0％，影像学成功率为84．0％。15例重建股骨头手术后DSA评估提示血管蒂充盈好，骨瓣血运丰富。结论股骨头骨折内固定术后股骨头坏死发生率较高（可达40％）。在取出内固定物同时行带血运骨瓣转移治疗股骨头缺血性坏死、股骨头血运重建良好，早期疗效满意。

Objective To research on treament of femoral head of patients with osteonecrosis of the femoral head fracture. Methods Twenty-six patients half of femaoral head of patients with osteonecrosis of the femoral head fracture who treated with vascularzed bone graft were determined. Twenty-one hips treat- ed with internal fixation unloaded and vascularzed bone graft after selective digital subtraction angiography （DSA） was performed to confirm the blood supply of femoral head. one case underwent total hip replacement after internal fixation unloaded. Results All patients were followed up for a mean of 23 months （range, 12-38months）and were assessed clinically and radiologically according to Harris scoring. Selective digital subtraction angiography （DSA） was performed in 15 cases to confirm the blood reconstruction of femoral head. Two eases underwent total hip replacement postoperatively. Preoperative and postoperative Harris score were 54 and 86.2, clinical success rate was 92.0% and radiological success rate was 84.0%. DSA demonstrated blood supply was found reconstruction in the necrotic femoral head. Conclusion Femoral head of patients with osteoneerosis of the femoral head fracture was very much （recent 40%）. Taking out of internal fixation, treatment of osteonecrosis of the femoral head by using vascularzed bone graft was confirmed, early clinical results were satisfied.