对易退加压螺丝钉与骨瓣移植治疗股骨颈骨折的临床评价

Clinical Evaluation of Easily Taken Out Lag Screws Combined with Bone Pedicle Grafts for Treatment of Femoral Neck Fracture

目的：设计并临床应用易退加压螺丝钉治疗股骨颈骨折，同时移植带肌（血管）蒂骨瓣，提高骨折愈合率，减少骨不连及股骨头缺血性坏死率，并便于骨折愈合后拔钉。方法：在松质骨加压螺丝钉的基础上，将螺纹的后部增加３～５圈由深逐渐变浅（呈锥形）的螺纹。术中分别于股骨颈张力侧和压力侧植入该钉各１枚，同时于股骨颈前上方刻槽并植入带肌（血管）蒂的髂骨瓣。术后早期功能锻炼，８～１０个月开始负重。结果：１０２例中、青年股骨颈骨折应用易退加压螺丝钉＋带肌（血管）蒂骨瓣移植病人中，８９例获得随访，随访时间平均为４２个月，其中优良率９２１％，尚可５６％，骨延迟愈合和骨不连接各１例（２３％）而再次手术。２６例因骨折愈合达２年以上而要求取钉，证实该钉拔除容易。结论：易退加压螺丝钉内固定治疗股骨颈骨折，效果确切，愈后便于拔钉；同步植入肌（血管）蒂骨瓣可促进股骨头早期血供的建立及复活，加速骨折愈合过程，提高股骨头的成活率。

Objective:To increase the cure rate of femoral neck fracture,cut down the rate of nonunion or avascular necrosis of femoral head,and facilitate taking out the screws.Methods:The easily taken out screw was based on the cancellous screw,added 3～5 circles which diameter decreased step by step to the rear of the circles.In the operation,one of the screws was screwed into the tension side of femoral neck,and the other was put into the pressure side.At the same time,the iliac bone lamella with muscle pedicle (or blood vessels pedicle)was transplanted in the hollow of femoral neck.In early postoperation the patients were enable to move,but they couldnt load until it was 8～10 months after operation.Results:Of the 102 young and middle aged patients treated by the screws and the bone graft,89 cases were followed up,the average time was 42 months.The excellent and good rate was 92 1%,the fair rate was 5 6%.There was separately one patient who was reoperated because of nonunion or delayed union(2 3%).26 patients requested taking out the screws after 2 years since bone union,and the screws could be easily taken out.Conclusion:It was effective that using the easily taken out lag screws to treat fracture of femoral neck,transplanting the pedicle bone lamella could early promote the circulation formation and revival of femoral head.