带蒂股方肌骨瓣移植空心加压螺钉内固定治疗青壮年不稳定型股骨颈骨折65例分析

Analysis of feasibility of quadratus femoris muscle pedicle bone graft with hollow compress screw fixation in the treatment of unstable femoral neck fracture in 65 cases

目的评价股方肌带蒂肌骨瓣移植空心加压螺钉内固定治疗不稳定型股骨颈骨折的可行性。方法采用前瞻性研究,对本院65例青壮年股骨颈骨折患者采用髋关节后外侧切口,进行股骨颈切开复位,空心加压螺钉固定,股方肌带蒂骨瓣植骨,观察受伤至手术的时间,骨折部位及粉碎程度,术后是否早期负重与骨折愈合及股骨头坏死的关系。结果经过6～60个月的随访,功能评定按Harris评分标准,优42例,良18例,优良率为92.3%,骨折全部愈合,愈合率为100%,愈合时间为6～12个月,平均8个月,5例股骨头缺血坏死(其中1例为陈旧性骨折),股骨头坏死率为7.7%。结论青壮年不稳定型股骨颈骨折能给予及时有效的复位、内固定及股方肌带蒂肌骨瓣移植(提供了充足的血供),并给予正确的康复指导,可以提高骨折愈合率,减少股骨头缺血坏死的发生率。本术式不失为基层医院治疗青壮年不稳定型股骨颈骨折非常有效的方法。

Objective To evaluate the feasibility of quadratus femoris muscle pedicle bone graft with hollow compress screw fixation in the treatment of unstable femoral neck fracture. Methods By a prospective study, 65 patients with femoral neck fractures in our hospital were treated by hollow compress screw fixation and quadratus femoris muscle pedicle bone graft with open reduction through posterolateral hip incision. The time from injury to surgery, the fracture site and the degree of comminuted, the relationship of early weight bearing after operation and fracture healing or femoral head necrosis were observed. Results All patients were followed up for 6-60 months. By Harris score of the hip joint function, the results were excellent in 42 cases, good in 18 cases, the excellent and good rate was 92.3%. All patients with fractures were healed, the healing rate was 100%, and the healing time was 6-12 months （average 8 months）. 5 cases of them occurred femoral head necrosis （1 case was old fracture）, and the rate of femoral head necrosis was 7.7%. Conclusion The treatment of unstable femoral neck fracture in young adults with timely and effective reduction, internal fixation, quadratus femoris muscle pedicle hone graft （to provide adequate blood supply） and to give the correct guidance of rehabilitation can improve the healing rate and reduce the rate of femoral head necrosis. This technique may well be a very effective method to treat young adults unstable femoral neck fracture in the primary hospital.