股方肌骨瓣移植术治疗青壮年股骨颈骨折中远期随访

Study on the long-term effects of the quadratus femoris muscle pedicle bone graft with screw fixation for the treatment of femoral neck fractures in young adults

目的:对股方肌骨瓣移植加空心螺钉固定治疗青壮年股骨颈骨折疗效进行分析。方法:自2002年5月至2008年12月,收治38例股骨颈骨折患者,男22例,女16例;平均年龄40岁(25～60岁)。根据Garden分型,Ⅱ型25例,Ⅲ型13例。36例急诊手术,2例延期手术。根据Sanders临床评分标准和X线评分标准进行评分,在疼痛、行走、功能、肌力和日常活动等方面进行评价。结果:38例随访2～5年,术后与术前评分比较差异有统计学意义(P<0.05)。所有患者骨折愈合,愈合时间平均5个月。所有患者在不扶拐杖下能独立行走,无并发症发生。结论:股方肌骨瓣移植加空心螺钉固定治疗青壮年股骨颈骨折愈合率高,并发症少,操作简单,成功率高,中远期疗效好。

Objective：To analyze the long term effects of the quadratus femoris muscle pedicle bone graft with screw fixation for the treatment of femoral neck fractures in young adults. Methods：From 2002 to 2008,38 patients with femoral neck fractures were operated. There were 22 males and 16 females,with an average age of 40 years（ranged 25 to 60 years）. Twenty six patients injured from high velocity road traffic accident,among which 14 patients injured in automobile accident,8 in two wheeler accident and 4 in fall from height. Twelve patients had serious associated injuries. Femoral neck fractures were classified by Garden classification：25 patients were GradenⅡand 13 patients were Graden Ⅲ. Thirty six patients underwent emergency operation and 2 had delayed operation. Clinical scores were evaluated based on Sanders scores and the radiological criteria which was judged by the diminution of density in the necrotic portion of the femoral head. Results：All the patients were followed up for at least 2 years（ranged 2 to 5 years）. There were significant differences between preoperation and postoperation in pain,function,muscle power and walk ability. All the patients with fractures were healed in an average of 5 months after operation and walked without aids and no complications occurred. Conclusion：This technique provides a high union rate with a low complication rate. In addition,the surgical procedure is relatively simple and has a nice long term result.