吻合血管腓骨移植结合交叉穿针外固定治疗中青年陈旧性股骨颈骨折

Free vascularized fibular graft associated with intertrochanteric cross external fixation to treat old femoral neck fracture

目的探索中青年陈旧性股骨颈骨折的治疗方法。方法陈旧性股骨颈骨折复位满意后。从大转子外下方．经皮沿股骨颈平行钻入3枚4mm斯氏针，穿过骨折线达到股骨头下方，在大转子外上方向小转子部位钻入相同直径的2枚斯氏针。皮外的针尾部分与外固定器连接。在股骨颈上开槽并伸入股骨头内；切取对侧带血管腓骨，嵌入开槽内，用一枚螺丝钉固定，将腓骨动、静脉与旋股外动、静脉升支吻合。结果治疗31例，随访3～15年27例，失访4例。骨折愈合时间为4～9个月，术后并发股骨头坏死4例，占14．81％。结论转子间交叉穿针外固定支架固定避免了斯氏针穿过股外侧肌肉群，有利于髋、膝关节的早期活动；外固定器及斯氏针在体外连成一个牢固的弹性固定系统，可有效的对抗骨折端的剪切应力，有利于功能恢复。吻合血管腓骨移植有利于骨折愈合，降低了股骨头坏死的风险。

Objective To explore a new kind of treatment for femoral neck fracture. Methods After a satisfactory reduction, paralleling to each other,crossing the fracture line, 3 Steinmann＇s pin which diameter is 4 mm were inserted into femoral neck by per cuter at the distal-lateral area of great trochanter, until under the subchondral area of femoral neck. Then another 2 pins were inserted into lesser trochanter from the upper-lateral area of greater trochanter. The end of pins were fixed with the external fixation designed by ourselves. A tunnel was made in the femoral neck, and the opposite vasculerized fibular was cut , then inserted it into the tunnel and fixed it with a screw meanwhile the fibular vessels were inosculated with the upper vessels of lateral circumflex femoral branches. Results Thirty-one cases were treated by this method, and 27 cases were followed up for 3-15 years, of the 27 cases were cured within 4-9 months. 4 cases has developed into osteonecrosis of femoral head （14.81%）. Conclusion The method can avoid the traversing hurt of lateral femoral muscles by pins, allowed more early exercise of hip and knee; External fixation and pins construct a so-called firmly and elastic fixation system,which can restricts the pins mobilization and counteracts the shear stress, thus, facilitates the union of fracture and the restoration of function.