带血管蒂大转子骨膜瓣修复儿童股骨颈骨折的25例报告

Treatment of Femoral Neck Fracture with Vascularized Great Trochanter Periosteal Flap Transposition in Children

目的:探讨带血管蒂大转子骨膜瓣转位治疗儿童股骨颈骨折的疗效。方法:25例儿童股骨颈骨折患者,骨折按Delbet分型:Ⅰ型2例,Ⅱ型13例,Ⅲ型9例,Ⅳ型1例。全部病例均行切开复位,克氏针或空心加压螺钉固定,并用旋股内侧动脉深支蒂大转子骨膜瓣转位治疗。结果:所有病例经1-5年随访(其中20例随访3年以上),骨折均愈合。2例Ⅱ型及1例Ⅲ型发生股骨头坏死,1例发生骨骺早闭。按Harris髋关节功能评分系统评定:优15例,良好7例,差3例,优良率达88.0%。结论:带血管蒂大转子骨膜瓣可促进骨折愈合,减少股骨头缺血性坏死的发生率,是治疗儿童股骨颈骨折的有效方法。

Objective. To evaluate the therapeutic effects of the femoral neck fractures with vascularized great trochanter periosteal flap transposition in children. Methods： Twenty-five children with femoral neck fractures were reviewed. And according to Delbet classification, two cases were type I , thirteen were type II , nine were type Ⅲ, and one was type IV. All the patients were treated with open diaplasis, multi-pin or hollow screws fixation, and vascularized great trochanter periosteal flap transposition. Results： All cases were followed up between one and five years （twenty patients were followed up for more than three years）. All the fractures reached absolutly healing except that one patient had femoral neck shortening with epiphyseal plate closing early, and two patients and one patient respectively had type Ⅱ and type Ⅲ avascular necrosis of the femoral head. According to Harris hip score, 15 patients had excellent results, seven were good and three were fair. The excellent and good rate was 88%. Conclusion. The treatment with vascularized great trochanter periosteal flap transposition could promote the healing of fracture, and decrease the rate of avascular necrosis of the femoral head. It is an effective method for the treatment of femoral neck fractures in children.